Top

Published in:

Open Access 01-12-2020 | Hydrocephalus | Review Article

Systematic review of pineal cysts surgery in pediatric patients

Authors: Joham Choque-Velasquez, Roberto Colasanti, Szymon Baluszek, Julio Resendiz-Nieves, Sajjad Muhammad, Christopher Ludtka, Juha Hernesniemi

Published in: Child's Nervous System | Issue 12/2020

Abstract

Introduction

We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments.

Methods

The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles.

Results

The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001).

Conclusions

Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures.

Available only for authorised users

Mamourian AC, Towfighi J (1986) Pineal cysts: MR imaging. AJNRAmerican journal of neuroradiology 7:1081–1086

Al-Holou WN, Garton HJ, Muraszko KM et al (2009) Prevalence of pineal cysts in children and young adults. Clinical article. Journal of neurosurgeryPediatrics 4:230–236. https://doi.org/10.3171/2009.4.PEDS0951CrossRef

Al-Holou WN, Terman SW, Kilburg C et al (2011) Prevalence and natural history of pineal cysts in adults. Journal of Neurosurgery 115:1106–1114. https://doi.org/10.3171/2011.6.JNS11506CrossRefPubMed

Cauley KA, Linnell GJ, Braff SP, Filippi CG (2009) Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center. AJRAmerican journal of roentgenology 193:533–537. https://doi.org/10.2214/AJR.08.1906CrossRef

Lacroix-Boudhrioua V, Linglart A, Ancel PY et al (2011) Pineal cysts in children. Insights into imaging 2:671–678. https://doi.org/10.1007/s13244-011-0117-0CrossRefPubMedPubMedCentral

Nevins EJ, Das K, Bhojak M, Pinto RS, Hoque MN, Jenkinson MD, Chavredakis E (2016) Incidental pineal cysts: is surveillance necessary? World Neurosurgery 90:96–102. https://doi.org/10.1016/j.wneu.2016.02.092CrossRefPubMed

Gokce E, Beyhan M (2018) Evaluation of pineal cysts with magnetic resonance imaging. World Journal of Radiology 10:65–77. https://doi.org/10.4329/wjr.v10.i7.65CrossRefPubMedPubMedCentral

Hasegawa A, Ohtsubo K, Mori W (1987) Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases. Brain Research 409:343–349. https://doi.org/10.1016/0006-8993(87)90720-7CrossRefPubMed

Jussila MP, Olsen P, Salokorpi N, Suo-Palosaari M (2017) Follow-up of pineal cysts in children: is it necessary? Neuroradiology 59:1265–1273. https://doi.org/10.1007/s00234-017-1926-8CrossRefPubMed

10.

Berhouma M, Ni H, Delabar V et al (2015) Update on the management of pineal cysts: case series and a review of the literature. Neuro-Chirurgie 61:201–207. https://doi.org/10.1016/j.neuchi.2013.08.010CrossRefPubMed

11.

Eide PK, Ringstad G (2017) Results of surgery in symptomatic non-hydrocephalic pineal cysts: role of magnetic resonance imaging biomarkers indicative of central venous hypertension. Acta Neurochirurgica 159:349–361. https://doi.org/10.1007/s00701-016-3029-4CrossRefPubMed

12.

Fain JS, Tomlinson FH, Scheithauer BW et al (1994) Symptomatic glial cysts of the pineal gland. Journal of Neurosurgery 80:454–460. https://doi.org/10.3171/jns.1994.80.3.0454CrossRefPubMed

13.

Hajnsek S, Paladino J, Gadze ZP, Nanković S, Mrak G, Lupret V (2013) Clinical and neurophysiological changes in patients with pineal region expansions. Collegium Antropologicum 37:35–40PubMed

14.

Damaty AE, Fleck S, Matthes M, et al (2019) Pineal cyst without Hydrocephalus: Clinical Presentation and Postoperative Clinical Course After Infratentorial Supracerebellar Resection. World neurosurgery. https://doi.org/10.1016/j.wneu.2019.05.200, Pineal cyst without hydrocephalus: clinical presentation and postoperative clinical course after infratentorial supracerebellar resection

15.

Koziarski A, Podgorski A, Zielinski GM (2019) Surgical treatment of pineal cysts in non-hydrocephalic and neurologically intact patients: selection of surgical candidates and clinical outcome. British Journal of Neurosurgery 33:37–42. https://doi.org/10.1080/02688697.2018.1530731CrossRefPubMed

16.

Pitskhelauri DI, Konovalov AN, Abramov IT, Danilov GV, Pronin IN, Alexandrova EV, Serova NK, Sanikidze AZ (2019) Pineal cyst-related aqueductal stenosis as cause of intractable headaches in nonhydrocephalic patients. World Neurosurgery 123:e147–e155. https://doi.org/10.1016/j.wneu.2018.11.096CrossRefPubMed

17.

Kalani MY, Wilson DA, Koechlin NO et al (2015) Pineal cyst resection in the absence of ventriculomegaly or Parinaud’s syndrome: clinical outcomes and implications for patient selection. Journal of Neurosurgery 123:352–356. https://doi.org/10.3171/2014.9.JNS141081CrossRefPubMed

18.

Fedorko S, Zweckberger K, Unterberg AW (2018) Quality of life following surgical treatment of lesions within the pineal region. Journal of Neurosurgery:1–10. https://doi.org/10.3171/2017.7.JNS17260

19.

Kreth FW, Schatz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB (1996) Stereotactic management of lesions of the pineal region. Neurosurgery 39:280–289 discussion 289-91CrossRefPubMed

20.

Majovsky M, Netuka D, Benes V (2017) Conservative and surgical treatment of patients with pineal cysts: prospective case series of 110 patients. World Neurosurgery 105:199–205. https://doi.org/10.1016/j.wneu.2017.05.155CrossRefPubMed

21.

Mena H, Armonda RA, Ribas JL, Ondra SL, Rushing EJ (1997) Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Annals of Diagnostic Pathology 1:11–18. https://doi.org/10.1016/s1092-9134(97)80004-4CrossRefPubMed

22.

Choque-Velasquez J, Resendiz-Nieves JC, Rezai Jahromi B et al (2019) The microsurgical management of benign pineal cysts: Helsinki experience in 60 cases. Surgical Neurology International 10:103. https://doi.org/10.25259/SNI-180-2019CrossRefPubMedPubMedCentral

23.

Kahilogullari G, Massimi L, Rocco CD (2013) Pineal cysts in children: case-based update. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 29:753–760. https://doi.org/10.1007/s00381-012-2011-6CrossRef

24.

Hardin AP, Hackell JM (2017) Age limit of pediatrics. Pediatrics 140:. https://doi.org/10.1542/peds.2017-2151

25.

(1988) American Academy of Pediatrics Council on Child and Adolescent Health: age limits of pediatrics. Pediatrics 81:736

26.

Arevalo A, Pulido-Rivas P, Gilo-Arrojo F, Sola RG (2016) Haemorrhagic pineal cysts: two clinical cases successfully treated by means of microsurgery. Revista de Neurologia 63:206–210. https://doi.org/10.33588/rn.6305.2016128CrossRefPubMed

27.

Behrens P, Ostertag CB (1993) Stereotactic procedure in pineal cysts. Fortschritte der Neurologie-Psychiatrie 61:284–289. https://doi.org/10.1055/s-2007-999096CrossRefPubMed

28.

Čapek Š, Škvor E, Neubertová E, Sameš M (2014) Microsurgical resection of symptomatic pineal cysts. Ceska a Slovenska Neurologie a Neurochirurgie 77:90–95

29.

Day GA, McPhee IB, Tuffley J, et al (2007) Idiopathic scoliosis and pineal lesions in Australian children. Journal of orthopaedic surgery (Hong Kong) 15:327–333. https://doi.org/10.1177/230949900701500318 [doi]

30.

Chirico AD, Rocco FD, Velardi F (2001) Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 17:42–46. https://doi.org/10.1007/pl00013724CrossRef

31.

Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S, Jänisch W (2000) Cystic lesions of the pineal region–MRI and pathology. Neuroradiology 42:399–402CrossRefPubMed

32.

Fleege MA, Miller GM, Fletcher GP et al (1994) Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNRAmerican journal of neuroradiology 15:161–166

33.

Gaab MR, Schroeder HW (1998) Neuroendoscopic approach to intraventricular lesions. Journal of Neurosurgery 88:496–505. https://doi.org/10.3171/jns.1998.88.3.0496CrossRefPubMed

34.

Gomez-Arguelles JM, Mata P, Bermejo PE, Anciones B (2009) Worsening of migraine symptoms due to giant pineal cyst apoplexy. Revista de Neurologia 48:17–19. https://doi.org/10.33588/rn.4801.2008292CrossRefPubMed

35.

Hirata Y, Inoue T, Abe H, Takemoto K, Uda K, Oka K (2009) Neuroendoscopic treatment of pineal cysts: a case report and review of the literature. Japanese Journal of Neurosurgery 18:609–613. https://doi.org/10.7887/jcns.18.609CrossRef

36.

Klein P, Rubinstein LJ (1989) Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. Journal of Neurology, Neurosurgery, and Psychiatry 52:991–995. https://doi.org/10.1136/jnnp.52.8.991CrossRefPubMedPubMedCentral

37.

Knierim DS, Yamada S (2003) Pineal tumors and associated lesions: the effect of ethnicity on tumor type and treatment. Pediatric Neurosurgery 38:307–323. https://doi.org/10.1159/000070415CrossRefPubMed

38.

Koenigsberg RA, Faro S, Marino R, Turz A, Goldman W (1996) Imaging of pineal apoplexy. Clinical Imaging 20:91–94. https://doi.org/10.1016/0899-7071(94)00079-4CrossRefPubMed

39.

Leston J, Mottolese C, Champier J et al (2009) Contribution of the daily melatonin profile to diagnosis of tumors of the pineal region. Journal of Neuro-Oncology 93:387–394. https://doi.org/10.1007/s11060-008-9792-1CrossRefPubMed

40.

Majeed K, Enam SA (2007) Recurrent pineal apoplexy in a child. Neurology 69:112–114. https://doi.org/10.1212/01.wnl.0000265058.35804.f6CrossRefPubMed

41.

Mandera M, Marcol W, Bierzynska-Macyszyn G, Kluczewska E (2003) Pineal cysts in childhood. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 19:750–755. https://doi.org/10.1007/s00381-003-0813-2CrossRef

42.

Martin J, Neal C, Moores I, Ecklund J (2005) Use of a nitrogen arm-stabilized endoscopic microdriver in neuroendoscopic surgery. Minimally invasive neurosurgery : MIN 48:63–65. https://doi.org/10.1055/s-2004-830181CrossRefPubMed

43.

McNeely PD, Howes WJ, Mehta V (2003) Pineal apoplexy: is it a facilitator for the development of pineal cysts? The Canadian journal of neurological sciencesLe journal canadien des sciences neurologiques 30:67–71. https://doi.org/10.1017/s031716710000247xCrossRef

44.

Meyer S, Oberkircher N, Boing A et al (2013) Disturbance in melatonin metabolism as a causative factor for recurrent headaches in a girl with a pineal cyst? Acta Paediatrica (Oslo, Norway : 1992) 102:e51–e52. https://doi.org/10.1111/apa.12089CrossRef

45.

Michielsen G, Benoit Y, Baert E et al (2002) Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochirurgica 144:233–242; discussion 242. https://doi.org/10.1007/s007010200031CrossRefPubMed

46.

Miyatake S, Kikuchi H, Yamasaki T, Terashima T, Asahi M, Asato R, Higuchi K, Nakashima Y (1992) Glial cyst of the pineal gland with characteristic computed tomography, magnetic resonance imaging, and pathological findings: report of two cases. Surgical Neurology 37:293–299. https://doi.org/10.1016/0090-3019(92)90156-hCrossRefPubMed

47.

Morgan JT, Scumpia AJ, Webster TM et al (2008) Resting tremor secondary to a pineal cyst: case report and review of the literature. Pediatric Neurosurgery 44:234–238. https://doi.org/10.1159/000121382CrossRefPubMed

48.

Musolino A, Cambria S, Rizzo G, Cambria M (1993) Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature. Neurosurgery 32:315–320 discussion 320-1CrossRefPubMed

49.

Oeckler R, Feiden W (1991) Benign symptomatic lesions of the pineal gland. Report of seven cases treated surgically. Acta Neurochirurgica 108:40–44. https://doi.org/10.1007/bf01407665CrossRefPubMed

50.

Ozek E, Ozek MM, Caliskan M et al (1995) Multiple pineal cysts associated with an ependymal cyst presenting with infantile spasm. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 11:246–249CrossRef

51.

Pastel DA, Mamourian AC, Duhaime AC (2009) Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. Journal of neurosurgeryPediatrics 4:81–84. https://doi.org/10.3171/2008.5.17681CrossRef

52.

Plowey ED, Vogel H, Yeom KW et al (2014) Tectal pineal cyst in a 1-year-old girl. Human Pathology 45:653–656. https://doi.org/10.1016/j.humpath.2013.10.002CrossRefPubMed

53.

Sarikaya-Seiwert S, Turowski B, Hanggi D et al (2009) Symptomatic intracystic hemorrhage in pineal cysts. Report of 3 cases. Journal of Neurosurgery. Pediatrics 4:130–136. https://doi.org/10.3171/2009.4.PEDS08309CrossRefPubMed

54.

Sevitt S, Schorstein J (1947) A case of pineal cyst. British Medical Journal 2:490. https://doi.org/10.1136/bmj.2.4525.490CrossRefPubMedPubMedCentral

55.

Stern JD, Ross DA (1993) Stereotactic management of benign pineal region cysts: report of two cases. Neurosurgery 32:310–314 discussion 314CrossRefPubMed

56.

Stevens QE, Colen CB, Ham SD et al (2007) Delayed lateral rectus palsy following resection of a pineal cyst in sitting position: direct or indirect compressive phenomenon? Journal of Child Neurology 22:1411–1414. https://doi.org/10.1177/0883073807307094CrossRefPubMed

57.

Taraszewska A, Matyja E, Koszewski W, Zaczyński A, Bardadin K, Czernicki Z (2008) Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathologica 46:186–195PubMed

58.

Thaher F, Kurucz P, Fuellbier L et al (2014) Endoscopic surgery for tumors of the pineal region via a paramedian infratentorial supracerebellar keyhole approach (PISKA). Neurosurgical Review 37:677–684. https://doi.org/10.1007/s10143-014-0567-1CrossRefPubMed

59.

Turtz AR, Hughes WB, Goldman HW (1995) Endoscopic treatment of a symptomatic pineal cyst: technical case report. Neurosurgery 37:1013–1014 discussion 1014-5CrossRefPubMed

60.

Vorkapic P, Pendl G (1987) Microsurgery of pineal region lesions in children. Neuropediatrics 18:222–226. https://doi.org/10.1055/s-2008-1052485CrossRefPubMed

61.

Wisoff JH, Epstein F (1992) Surgical management of symptomatic pineal cysts. Journal of Neurosurgery 77:896–900. https://doi.org/10.3171/jns.1992.77.6.0896CrossRefPubMed

62.

Yang Y, Levy ML, Crawford JR (2016) Benign pineal cyst lined with normal choroid plexus mimicking tumour in a young girl with exotropia. BMJ case reports 2016:https://doi.org/10.1136/bcr-2015-214170

63.

Jouvet A, Derrington E, Pialat J, Lapras C, Fèvre-Montange M, Besançon R, Belin MF, Saint-Pierre G (1994) Structural and ultrastructural characteristics of human pineal gland, and pineal parenchymal tumors. Acta Neuropathologica 88:334–348. https://doi.org/10.1007/BF00310377CrossRefPubMed

64.

Kang HS, Kim DG, Han DH (1998) Large glial cyst of the pineal gland: a possible growth mechanism. Case report. Journal of neurosurgery 88:138–140. https://doi.org/10.3171/jns.1998.88.1.0138CrossRefPubMed

Title: Systematic review of pineal cysts surgery in pediatric patients
Authors: Joham Choque-Velasquez
Roberto Colasanti
Szymon Baluszek
Julio Resendiz-Nieves
Sajjad Muhammad
Christopher Ludtka
Juha Hernesniemi
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
Published in: Child's Nervous System / Issue 12/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04792-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Systematic review of pineal cysts surgery in pediatric patients

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2020

Multimodal assessment of motor pathways and intracortical connections in functional hemispherectomy

Role of routine post-operative CT brain following evacuation of extradural haematoma in children: a single-centre experience

Ultrasound-guided percutaneous brachiocephalic vein cannulation for ventriculoatrial shunt placement in a child

Is perinatal arterial ischemic stroke common?

Styloidogenic jugular venous compression syndrome: a case report and review of the literature

Biomarkers in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia