title: Incidental Pineal Cysts: Is Surveillance Necessary?
abstract: OBJECTIVE
  The natural history of incidental pineal cysts is poorly understood. Neurosurgeons and neuroradiologists are more frequently faced with this disease in the advent of higher-resolution magnetic resonance imaging (MRI) scanning. We aim to suggest a suitable surveillance strategy for these patients.
  
  
  METHODS
  All patients who had MRI of the brain between June 2007 and January 2014 (n = 42,099) at The Walton Centre for Neurology and Neurosurgery were included. Radiologic reports containing the terms "pineal" and "cyst" were reviewed to identify patients.
  
  
  RESULTS
  A total of 281 patients were identified with pineal cysts. The principal indication for head MRI was headache (50.2%), although no symptoms were deemed attributable to pineal disease. A total of 178 patients (63.3%) were female, and the age at diagnosis ranged from 16 to 84 years. The median size of pineal cyst at diagnosis was 10 mm. A total of 181 patients had subsequent follow-up at a median time of 6 months (range, 1-68). Eleven pineal cysts (6%) changed size during the follow-up period. Four patients had a reduction in cyst size; the median change was 2.5 mm. A further 7 pineal cysts increased in cyst size; the median change was 2 mm. No patients developed complications.
  
  
  CONCLUSIONS
  Incidental pineal cysts typically show a benign course. In the adult population, they do not require long-term neurosurgical follow-up, because pineal cysts tend to remain a stable size. In asymptomatic patients, we recommend a single follow-up MRI scan at 12 months to confirm diagnosis. The patient should then be discharged if the cyst remains stable.
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: dr.e.nevins@gmail.com.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Nevins
authors.affiliation: Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Kumar
authors.initials: K
authors.lastname: Das
authors.affiliation: Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Bhojak
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Rohan S
authors.initials: RS
authors.lastname: Pinto
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Hoque
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jenkinson
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chavredakis
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D020863:Central Nervous System Cysts / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010871:Pinealoma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Asymptomtic; Epidemiology; Follow-Up; Incidental; Pineal cyst; Surveillance