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Endoscopic Third Ventriculostomy and Pineal Biopsy from a Single Entry Point
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Pineal gland cysts--an overview.

Jelena Bosnjak1, Mislav Budisić, Drazen Azman

  • 1University Department of Neurology, Reference Center for Neurovascular Disorders, Ministry of Health and Social Welfare of the Republic of Croatia, Sestre milosrdnice University Hospital, Zagreb, Croatia. jelenabosnjak78@gmail.com

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Pineal cysts are common, often asymptomatic, and typically diagnosed via MRI. Transcranial sonography shows promise for follow-up, with surgery reserved for symptomatic cases like hydrocephalus or neurological decline.

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Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Pineal cysts are frequently observed in adults, with prevalence varying across patient populations.
  • Magnetic resonance imaging (MRI) is the standard for diagnosing pineal cysts, differentiating them from tumors.
  • Transcranial sonography (TCS) shows potential as a complementary diagnostic and follow-up tool.

Purpose of the Study:

  • To review the prevalence, diagnosis, clinical implications, and management of pineal cysts.
  • To compare the efficacy of MRI and TCS in detecting pineal cysts.
  • To outline indications for surgical intervention and available surgical techniques.

Main Methods:

  • Review of magnetic resonance imaging (MRI) studies on pineal cyst prevalence.
  • Analysis of findings from transcranial sonography (TCS) studies.
  • Evaluation of clinical presentations and outcomes associated with pineal cysts.

Main Results:

  • Pineal cysts are found in 1.3%–4.3% of neurological patients and up to 10.8% of healthy volunteers.
  • TCS findings correlate well with MRI, suggesting its utility for follow-up examinations.
  • While often asymptomatic, symptomatic cysts can cause headaches, visual disturbances, and hydrocephalus, with size not always correlating to symptoms.

Conclusions:

  • Pineal cysts are common incidental findings, with TCS emerging as a valuable follow-up tool.
  • Surgical intervention is recommended for symptomatic pineal cysts, particularly those causing hydrocephalus or neurological deterioration.
  • Various surgical approaches, including neuroendoscopy, are available for tissue sampling and treatment.