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Which patients benefit from endoscopic surgery?

Pineal CystA few facts about pineal cysts:

  • Pineal cysts are fluid-filled spaces within the pineal gland.
  • The pineal gland sits nearly in the center of your brain, and is responsible for hormones related to sleep-wake cycle.
  • Pineal cysts are common, occurring in about 1-5% of the population.
  • These cysts are benign, which means not malignant or cancerous.
  • Sometimes an MRI of the pineal cyst needs to be repeated with an intravenous contrast (dye) to rule out a pineal tumor.
  • The cyst is rarely symptomatic; however, when symptoms do occur, they are difficult to attribute specifically to the pineal cyst.
  • Typical symptoms include headache, eye movement problems, vision disruption, and hydrocephalus (fluid backup in the brain).

Is surgery needed?

  • Very few pineal cysts require surgery. Most patients with a cyst have an MRI done and one is found incidentally, and they do not need treatment.
  • Most patients who need surgery have a cyst larger than 2 cm.
  • Often, another MRI with steady state needs to be done to see if there is tectal compression – a sign of local pressure.
  • A neuro-ophthalmologist can be very helpful in defining vision and eye movement problems, and can determine if these problems are related to the cyst.
  • If you and your neurosurgeon decide to pursue surgery, the cyst can be treated endoscopically, a minimally invasive procedure. During surgery, a camera will be used to make a hole in the cyst (called fenestration). This will cause the cyst to drain into your normal fluid spaces. The cyst can also be removed with an open craniotomy, but this procedure is usually only needed for cysts causing problems after fenestration.

To schedule an appointment, please call (919) 445-2410.

Carolyn Quinsey, MDDr. Carolyn Quinsey, MD, Pediatric and Adult Neurosurgeon