title: Update on the management of pineal cysts: Case series and a review of the literature.
abstract: OBJECTIVE
  The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established.
  
  
  METHODS
  From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented.
  
  
  RESULTS
  Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months.
  
  
  CONCLUSIONS
  In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France. Electronic address: berhouma.moncef@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Berhouma
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
authors.forename: H
authors.initials: H
authors.lastname: Ni
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
authors.forename: V
authors.initials: V
authors.lastname: Delabar
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
authors.forename: N
authors.initials: N
authors.lastname: Tahhan
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
authors.forename: S
authors.initials: S
authors.lastname: Memou Salem
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
authors.affiliation: Department of Neurosurgery B, Pierre-Wertheimer Neurological and Neurosurgical Hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France; Research and Education Unit of Medicine, Claude-Bernard University Lyon 1, 59, boulevard Pinel, 69500 Bron, France.
authors.forename: B
authors.initials: B
authors.lastname: Vallee
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000379:methods; D014696:Ventriculostomy / Q000379:methods
keywords: Diagnostic and operative techniques; Diagnostic et techniques opératoires; Endoscopie; Endoscopy; Glande pinéale; Histoire naturelle; IRM; Kyste pinéal; MRI; Natural history; Pineal cyst; Pineal gland