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Diseases

Genetic and Rare Diseases Information Center (GARD)

Pineal cyst

*

* Not a rare disease

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Treatment

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How might pineal cysts be treated?

The best treatment options for pineal cysts depend on many factors, including the size of the cyst and whether or not it is associated with symptoms. For example, people with pineal cysts that do not cause symptoms may not require any form of treatment.[1] However, they may need to have regular check-ups with a physician and follow up imaging if they have a large cyst (greater than 10-14 mm) or develop symptoms that could be related to the cyst.[1]

Treatment is often recommended for those individuals with pineal cysts that cause hydrocephalus; neurological symptoms such as headache or disturbance of vision; or enlargement of the cyst over time.[2][3] 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.[4] Radiation therapy may be recommended for cysts that recur after treatment.[1]
Last updated: 3/27/2015

What is the appropriate follow-up for a pineal cyst found incidentally on MRI?

There is limited information about what happens to a pineal cyst over time.  Several studies have shown that most pineal cysts remain stable and do not increase in size or cause symptoms later in life.[5][6]  One study found that larger cysts were more likely to decrease in size over time[5], and there is currently no evidence that larger cysts are more likely to cause symptoms.[6]  

Because guidelines for management depend on an understanding of the typical course of a condition, and currently there is limited information about pineal cysts, there is some debate about the most appropriate way to manage these cysts.[7]  Some studies do not recommend repeated magnetic resonance imaging (MRI) of the cyst.[7]  Other studies state that repeated imaging of a pineal cyst is not required.[5]  Another approach is for individuals with a pineal cyst to have regular check-ups with their personal doctor; if at any point new symptoms arise that may be related to the pineal cyst, repeat imaging should be done.[7][6]
Last updated: 3/27/2015

References
  1. Maria Moschovi, MD; George P Chrousos, MD. Pineal Gland Masses. UpToDate. October 2013;
  2. Taraszewska A, Matyja E, Koszewki W, Zaczynski A, Bardadin K, Czernicki Z. Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathol. 2008; 46(3):186-195.
  3. Al-Holou WN, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. February 2010; 5(2):162-166.
  4. 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.
  5. 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.
  6. Barboriak DP, Lee L, Provenzale JM. Serial MR imaging of pineal cysts: implications for natural history and follow-up. Am J Roentgenol. 2001; 176:737-743. http://www.ncbi.nlm.nih.gov/pubmed/11222216. Accessed 12/31/2013.
  7. 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.


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