title: Results of surgery in symptomatic non-hydrocephalic pineal cysts: role of magnetic resonance imaging biomarkers indicative of central venous hypertension.
abstract: We have previously proposed that pineal cysts (PCs) may result in crowding of the pineal recess, causing symptoms due to compression of the internal cerebral veins and central venous hypertension. In the present study, we compared clinical outcome of different treatment modalities in symptomatic individuals with non-hydrocephalic PCs.
  
  
  
  The study included all patients managed surgically for non-hydrocephalic PCs in our Department of Neurosurgery over a 10-year period. We applied a questionnaire to determine occurrence of symptoms before and after surgery, which allowed the use of a grading scale for symptom severity. Magnetic resonance imaging (MRI) biomarkers indicative of central venous hypertension were assessed before and after surgery.
  
  
  
  Relief of symptoms after surgery was most efficiently obtained by complete microsurgical cyst removal [n = 15; no (0/15), some (1/15) or marked (14/15) improvement], and to a lesser extent by microsurgical cyst fenestration [n = 6; no (2/6), some (4/6) or marked (0/6) improvement]. Shunt surgery was not successful [n = 6; no (5/6), some (1/6) or marked (0/6) improvement]. In all patients, the proposed MRI biomarkers gave evidence of central venous hypertension (PC grades 2-4).
  
  
  
  Microsurgical cyst removal provided marked symptom relief in symptomatic individuals with non-hydrocephalic PCs and MRI biomarkers of central venous hypertension. The hypothesis that PC-induced crowding of the pineal recess may compromise venous run-off and induce a central venous hypertension syndrome deserves further study.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Postboks 4950, Nydalen, 0424, Oslo, Norway. p.k.eide@medisin.uio.no.|Faculty of Medicine, University of Oslo, Oslo, Norway. p.k.eide@medisin.uio.no.
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Eide
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Ringstad
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery*; D020542:Third Ventricle / Q000473:pathology
keywords: Central venous hypertension; MRI; Pineal cysts; Pulsatile intracranial pressure; Surgery