title: Clinical management of pineal cysts: a worldwide online survey.
abstract: BACKGROUND
  A pineal cyst is a benign affection of a pineal gland on the borderline between a pathological lesion and a variant of normality. Clinical management of patients with a pineal cyst remains controversial, especially when patients present with non-specific symptoms.
  
  
  METHODS
  An online questionnaire consisting of 13 questions was completed by 110 neurosurgeons worldwide. Responses were entered into a database and subsequently analysed.
  
  
  RESULTS
  Based on data from the questionnaire, the main indication criteria for pineal cyst resection are hydrocephalus (90 % of the respondents), Parinaud's syndrome (80 %) and growth of the cyst (68 %). Only 15 % of the respondents occasionally operate on patients with non-specific symptoms. If surgery is indicated, improvement is expected in 88 % of the patients. The vast majority of the respondents favour a supracerebellar infratentorial approach to the pineal region. Most (78 %) of the respondents regarded the patient registry as a potentially useful instrument.
  
  
  CONCLUSIONS
  This survey sheds light on the current practice of pineal cyst management across the world. Most of the respondents perform surgery on pineal cysts only if patients are presenting with symptoms attributable to a mass effect. Surgery for patients with non-specific complaints (headache, vertigo) is not widely accepted, although it may prove effective. A prospective patient registry might be useful in the decision-making process in the clinical management of pineal cysts.
authors.affiliation: Department of Neurosurgery of 1st Faculty of Medicine of Charles University, Military University Hospital Prague, U Vojenske nemocnice 1200, Prague, Czech Republic. martin.majovsky@uvn.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Májovský
authors.affiliation: Department of Neurosurgery of 1st Faculty of Medicine of Charles University, Military University Hospital Prague, U Vojenske nemocnice 1200, Prague, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Netuka
authors.affiliation: Department of Neurosurgery of 1st Faculty of Medicine of Charles University, Military University Hospital Prague, U Vojenske nemocnice 1200, Prague, Czech Republic.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Beneš
mesh_terms: D000328:Adult; D020863:Central Nervous System Cysts / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D000069471:Neurosurgeons / Q000523:psychology; D019635:Neurosurgical Procedures / Q000379:methods* / Q000523:psychology; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: Headache; Management; Neurosurgery; Pineal cyst; Pineal gland