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The natural history of pineal cysts in children and young adults
Wajd N Al-Holou1, Cormac O Maher, Karin M Muraszko
1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-5338, USA.
Insights
Pediatric pineal cysts are common and usually stable. Younger children with pineal cysts are more likely to experience growth or changes, suggesting follow-up may be optional for older pediatric patients.
Area of Science:
- Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Pineal cysts are common incidental findings in pediatric neuroimaging.
- Understanding their natural history is crucial for appropriate clinical management.
Purpose of the Study:
- To define the natural history and clinical relevance of pediatric pineal cysts.
- To identify factors predicting cyst growth or change.
Main Methods:
- Retrospective review of 106 pediatric patients (<25 years) with pineal cysts.
- Analysis of clinical evaluations and serial magnetic resonance (MR) imaging over at least 6 months.
- Correlation of age, sex, initial cyst size, and imaging appearance with follow-up changes.
Main Results:
- Most pineal cysts (98/106) remained stable in size and appearance on follow-up MR imaging.
- Younger age at diagnosis was significantly associated with cyst growth or change (mean age 5.5 years vs. 12.2 years).
- Initial cyst characteristics and patient sex did not predict growth or change.
Conclusions:
- Pediatric pineal cysts typically exhibit a stable natural history.
- Follow-up imaging and neurosurgical evaluation may be considered optional for older children with pineal cysts.
Object:
The authors reviewed their experience with pediatric pineal cysts to define the natural history and clinical relevance of this common intracranial finding.
Methods:
The authors identified all patients with pineal cysts who had been clinically evaluated at their institution over an 11.5-year interval and were < 25 years of age at the time of diagnosis. All inclusion criteria were met in 106 patients, and included repeated MR imaging as well as repeated clinical evaluation over at least a 6-month interval.
Results:
The mean age at diagnosis was 11.7 +/- 7.2 years. Forty-two patients were male and 64 were female. On follow-up MR imaging evaluation at a mean interval of 3.0 years from the initial study, 98 pineal cysts had no increase in size and no change in imaging appearance. Six pineal cysts increased in size and 2 others had a change in imaging characteristics without associated growth. Younger age was associated with cyst change or growth on follow-up imaging (p = 0.02). The mean age of patients with cysts that changed or grew was 5.5 years, and the mean age of patients with stable pineal cysts was 12.2 years. Initial cyst size and appearance on MR imaging were not significant predictors of growth or change in imaging appearance at follow-up. Similarly, the patient's sex was not a significant predictor of growth or change in imaging characteristics.
Conclusions:
Follow-up imaging and neurosurgical evaluation may be considered optional in older children with pineal cysts.
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