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Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 54-62

Symptomatic improvement following resection of cystic pineal lesions

1 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
2 Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
3 Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA

Correspondence Address:
Dr. Sunil J Patel
Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJNO.IJNO_409_21

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Introduction: Pineal cysts have proven to be a challenging pathology for neurosurgeons. Due to occasional nonspecific symptoms, as well as a wide range of possible morphology and diagnoses, literature is scarce, and little evidence-based management guidelines exist. Methods: We present a retrospective review of 38 patients who underwent a surgical resection of a pineal lesion in a single center by a single surgeon between 2012 and 2018. Symptoms, imaging characteristics of the lesion, pathology report, and postoperative radiographic and clinical outcomes were collected. Results: Thirty-eight patients were selected. The most common preoperative symptoms included headaches (97%), visual disturbances (89%), cognitive disturbances (58%), and nausea/vomiting (53%). Preoperative radiographic measures showed no relationship to the pathological diagnosis of pineal cyst or pineocytoma (P > 0.05) except for mass effect on the tectal plate that was associated with pineocytoma (P < 0.05). Lesion pathology breakdown: 23 (60%) – World Health Organization Grade I pineocytoma, 14 (37%) – simple pineal cysts, and 1 (3%) – pineal parenchymal tumor of intermediate differentiation. The mean follow-up was 24 months. Headaches and visual disturbances were relieved in 78% and 58% of patients, respectively. Cognitive disturbances were found to be correlated with pineal cyst (P < 0.01). Patients with hyperintense fluid-attenuated inversion recovery signal and enhancement on preoperative magnetic resonance imaging were found to be at higher risk of not experiencing full symptom resolution (P < 0.05). Finally, if no symptom resolution occurred, then higher chance of patients not returning to work was seen (P < 0.05). Conclusion: Albeit challenging to treat, careful examination of presurgical imaging findings and surgical resection of appropriately selected pineal lesions can lead to significant relief of preoperative symptoms and overall meaningful improvement.

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