* Not a rare disease
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Questions on this page
- What are pineal cysts?
- What are the signs and symptoms of pineal cysts?
- Is there a correlation between pineal cyst size and symptoms?
- Are there any factors such as sex or age that influence the presence of or growth of pineal cyst?
- What causes pineal cysts?
- How might symptomatic pineal cysts be treated?
Pineal cysts are cysts of the pineal gland, a small organ in the brain shaped like the seed of a pine cone that is responsible for making melatonin, a hormone that regulates sleep. Pineal cysts may be found by chance in up to 10% of people undergoing CT or MRI brain imaging, and they occur in three times more women than men. Most pineal cysts do not cause symptoms and stay the same size over time (remain stable). In the rare circumstance where a pineal cyst does cause symptoms, it may cause headaches, hydrocephalus, eye movement abnormalities, and Parinaud syndrome. Because most pineal cysts do not grow or cause symptoms, there are no established guidelines for routine follow-up for individuals with pineal cysts. Treatment is usually only considered when a cyst is causing symptoms. In the past, treatment for symptomatic pineal cysts included surgery to remove the cyst (craniotomy); more recently, less invasive procedures such as stereotactic aspiration or endoscopic treatment have been recommended.
Last updated: 10/16/2012
Pineal cysts are usually asymptomatic. However, there are rare cases of pineal cysts which cause headaches, hydrocephalus, disturbances in vision (gaze palsy), Parinaud syndrome, and vertigo. In rare cases, individuals with symptomatic pineal cysts may have other symptoms such as difficulty moving (ataxia), mental and emotional disturbances, seizures, sleep (circadian rhythm) troubles, hormonal imbalances that may cause precocious puberty, or secondary parkinsonism.
Last updated: 12/29/2011
No. Symptomatic pineal cysts generally vary in size from 7 mm to 45 mm, whereas asymptomatic pineal cysts are usually less than 10 mm in diameter. One study of 151 individuals with asymtomatic pineal cysts found that half of the pineal cysts were smaller than 10mm and half were larger than 10mm in greatest dimension. In most cases, there does not seem to be a relationship between cyst size and the onset of symptoms.
Last updated: 8/18/2014
People of all ages have been found to have pineal cysts, although an increased prevalence has been found in older patients. The prevalence of the pineal cysts also appears to be slightly greater in women than men. Some have proposed that hormonal factors may account for the increased prevalence in women.
Last updated: 4/8/2010
Although the exact cause of pineal cysts is unknown, several theories have been proposed based on autopsy findings. One theory is that pineal cysts arise from the pineal recess in a part of the brain called the third ventricle. Others have proposed that they form because of reduced blood flow or the growth of glial plaques (deposits that buildup). According to another theory, pineal cysts form as a cluster of degenerated cells called pinealocytes.
Last updated: 4/8/2010
Whether patients with symptomatic pineal cysts should be monitored and/or treated is still unclear. However, surgery is usually recommended for those individuals with pineal cysts that cause hydrocephalus, worsening neurological symptoms such as headache or disturbance of vision, or enlargement of the cyst over time. Treatment may include surgery to remove the cyst, sometimes followed by the placement of a ventriculoperitoneal shunt. Aspiration of the contents of the cyst using ultrasound guidance has been explored as an alternative approach to surgery, and more recently, endoscopic procedures have been used.
Last updated: 12/29/2011
- Fakhran S, Escott EJ. Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging?. American Journal of Neuroradiology. 2008; 29:159-163. http://www.ncbi.nlm.nih.gov/pubmed/17925371. Accessed 12/13/2011.
- Al-Holou WN, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. 2010;
- Gaillard F, Jones J. Masses of the pineal region: clinical presentation and radiographic features. Postgraduate Medical Journal. 2010; 86:597-607. http://www.ncbi.nlm.nih.gov/pubmed/20971711. Accessed 12/13/2011.
- Costa F, Fornari M, Valla P, Servello D. Symptomatic Pineal Cyst: Case Report and Review of the Literature. Minim. Invas. Neurosurg.. 2008; 51:231-233.
- Wajd NA, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. 2010;
- Bosnjak J, Budisic M, Azman D, Strineka M, Crnjakovic M, Demarin V. Pineal gland cysts--an overview. Acta Clin Croat. 2009;
- Al-Holou WN, Terman SW, Kilburg C, Garton HJ, Muraszko KM, Chandler WF, Ibrahim M, Maher CO.. Prevalence and natural history of pineal cysts in adults. Journal of Neurosurgery. December, 2011; 115(6):1106-1114. http://www.ncbi.nlm.nih.gov/pubmed/21780858. Accessed 12/31/2013.
- Wajd NA, Garton HJL, Muraszko KM, Ibrahim M, Maher CO. Prevalence of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. 2009;
- Taraszewska A, Matyja E, Koszewki W, Zaczynski A, Bardadin K, Czernicki Z. Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathol. 2008;