Exclusively endoscopic management of complicated pineal cysts in young children: Definitive treatment through single burr-hole technique
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Updated: Sep 4, 2025
Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Baher Hanna1, Michael W Robinson2, Jesse Skoch1
1Department of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, Ohio, United States.
Insights
A novel endoscopic technique effectively treats pediatric pineal cysts with hydrocephalus. This minimally invasive approach offers a safe and durable solution for complex cases in children.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Minimally Invasive Surgery
Background:
- Management of complicated symptomatic pineal cysts in children presents challenges.
- Surgical options include craniotomy or endoscopic approaches, often addressing hydrocephalus separately.
- Existing methods for pediatric pineal cysts can be variable and invasive.
Purpose of the Study:
- To present a stepwise, minimally invasive technique for treating complicated pineal cysts in young children.
- To combine third ventriculostomy with intraventricular cyst marsupialization in a single procedure.
- To evaluate the safety and efficacy of this single-burr-hole endoscopic approach.
Main Methods:
- A novel technique involving endoscopic third ventriculostomy and intraventricular marsupialization of the pineal cyst was developed.
- The procedure utilized a single burr-hole and stereotactic navigation for precise instrument placement.
- This approach was applied to young children with symptomatic pineal cysts and obstructive hydrocephalus.
Main Results:
- Two pediatric patients with complicated pineal cysts and hydrocephalus were treated successfully.
- Both patients demonstrated positive outcomes with no complications after over two years of follow-up.
- This specific technique has not been previously described in the literature for this pediatric population.
Conclusions:
- Endoscopic third ventriculostomy combined with cyst marsupialization is a viable minimally invasive option for pediatric pineal cysts.
- This single-burr-hole technique facilitates rapid recovery and short hospital stays.
- The procedure establishes redundant cerebrospinal fluid flow pathways, ensuring durable outcomes.
Background:
The management of complicated symptomatic pineal cysts in the pediatric population is challenging and variable. Surgical management may include treatment of hydrocephalus alone, or direct treatment of the cyst with or without direct hydrocephalus management. This is typically done through craniotomy-based microsurgical approaches to the pineal region or an endoscopic transventricular approach.
Methods:
We present a stepwise minimally invasive technique to treat complicated pineal cysts in young children associated with an obstructive hydrocephalus in a single procedure through third ventriculostomy combined with an intraventricular marsupialization of the pineal cyst through a single burr-hole using stereotactic navigation.
Results:
Two young patients with over 2 years of follow-up have done well without complication using this technique. Other literature reports for complex pineal cysts in pediatric patients are reviewed and this technique is not previously described for this population.
Conclusion:
Endoscopic third ventriculostomy and cyst marsupialization using a single burr-hole and stereotactic navigation for symptomatic or enlarging pineal cysts in children allow for minimally invasive management, a rapid recovery, short hospital stay, and durable outcome owed to redundant CSF flow pathways.
