Incidental Pineal Cysts: Is Surveillance Necessary?

Area of Science:

• Neurology
• Radiology
• Oncology

Background:

• Incidental pineal cysts are increasingly detected due to advanced magnetic resonance imaging (MRI).
• The natural history and optimal surveillance strategies for these cysts are not well-defined.
• Neurosurgeons and neuroradiologists frequently encounter these incidental findings.

Purpose of the Study:

• To investigate the natural history of incidental pineal cysts.
• To propose a surveillance strategy for patients with pineal cysts.
• To determine if long-term neurosurgical follow-up is necessary.

Main Methods:

• Retrospective review of 42,099 brain MRI scans from June 2007 to January 2014.
• Identification of patients with pineal cysts through radiologic report keyword searches.
• Analysis of cyst size changes and clinical outcomes during follow-up.

Main Results:

• 281 patients with pineal cysts were identified; headache was the most common indication for MRI.
• 63.3% of patients were female, with ages ranging from 16 to 84 years.
• 6% of cysts changed size over a median follow-up of 6 months; no complications were observed.

Conclusions:

• Incidental pineal cysts generally follow a benign clinical course.
• Long-term neurosurgical follow-up is not required for stable, asymptomatic adult pineal cysts.
• A single follow-up MRI at 12 months is suggested for asymptomatic patients to confirm stability before discharge.