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Non,neoplastic pineal cysts

Departments of Neurology (Dr. Fetell), Neurosurgery (Drs. Bruce and Stein), Pathology (Drs. Torres and Powers), and Radiology (Dr. Cross), Columbia Presbyterian Medical Center, New York, NY, and the Department of Neurology (Dr. Burke), Northwestern University Medical Center, Chicago, IL.

We identified 53 patients with non-neoplastic cysts of the pineal gland. In contrast to patients with pineal neoplasms, pineal cysts are usually asymptomatic. They infrequently obstruct the aqueduct to cause hydrocephalus or compress the tectum to produce the neuro-ophthalmologic signs of dorsal midbrain dysfunction. Obstructive hydrocephalus was present in only five patients (9.4%); three of them showed clinical signs of Parinaud's syndrome. CT and MRI typically reveal a cystic mass that averages 1.6 cm in anteroposterior (A-P) diameter with calcification at the periphery and faint rim-like contrast enhancement. Sagittal MRI is the most useful diagnostic test because it shows the anatomic relationship of the cyst to the aqueduct. The mass may compress the tectum and distort the proximal aqueduct; occasionally a large cyst may occlude the aqueduct. All patients with obstructive hydrocephalus had cysts greater than 2.0 cm in A-P diameter. Nine patients had suboccipital craniotomy. In all of them, the cysts contained clear fluid and were easily removed. We advocate conservative management with clinical observation of these benign lesions that may be developmental variants of normal pineal gland.

Address correspondence and reprint requests to Dr. Michael R. Fetell, Neuro-oncology Unit, Columbia-Presbyterian Medical Center, New York Neurological Institute, 710 West 168th Street, New York, NY 10032-37.

Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.

Received August 28, 1990. Accepted for publication in final form December 10, 1990.

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