Prevalence and natural history of pineal cysts in adults

Clinical article

Restricted access


We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding.


The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst. We then identified all patients with pineal cysts who had been clinically evaluated at our institution and who had at least 6 months of clinical and imaging follow-up. All inclusion criteria for the natural history analysis were met in 151 patients.


Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478 patients (1.0%). Of these, 162 patients were male and 316 were female. On follow-up MR imaging of 151 patients with pineal cyst at a mean interval of 3.4 years from the initial study, 124 pineal cysts remained stable, 4 increased in size, and 23 decreased in size. Cysts that were larger at the time of initial diagnosis were more likely to decrease in size over the follow-up interval (p = 0.004). Patient sex, patient age at diagnosis, and the presence of septations within the cyst were not significantly associated with cyst change on follow-up.


Follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

Abbreviation used in this paper: EMERSE = the Electronic Medical Record Search Engine.

Article Information

Address correspondence to: Cormac O. Maher, M.D., Department of Neurosurgery, University of Michigan 1500 East Medical Center Drive, Room 3552, Taubman Center, Ann Arbor, Michigan 48109-5338. email:

Please include this information when citing this paper: published online July 22, 2011; DOI: 10.3171/2011.6.JNS11506.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Bar graph illustrating pineal cyst prevalence in patients undergoing brain MR imaging by age in years. Prevalence decreased with increasing age in the adult age range (univariate, p < 0.00001; multivariate with gender, p < 0.00001).

  • View in gallery

    Bar graph demonstrating pineal cyst prevalence in patients undergoing brain MR imaging by age in years and gender. Prevalence was greater in female patients in all age groups (univariate, p = 0.0001; multivariate with age, p = 0.004).

  • View in gallery

    Magnetic resonance images obtained in a 19-year-old man with an incidentally discovered pineal cyst that was initially found on CT following a minor injury. An initial MR imaging study (A) was performed to further evaluate the pineal cyst. The patient was found to be neurologically intact and was followed up with serial MR imaging at 16 months (B), 38 months (C), and 69 months (D). The pineal cyst is significantly smaller on the follow-up images.

  • View in gallery

    Bar graph showing pineal cyst prevalence in 48,417 consecutive adult patients and 14,516 consecutive pediatric patients undergoing MR imaging. Data for the pediatric age range are adapted from our prior analysis of pineal cyst prevalence in children. Cyst prevalence on MR imaging increases and peaks during childhood, then declines throughout adulthood.



Abreo KSteele TH: Pineal cyst associated associated with polycystic kidney disease: case report. Am J Kidney Dis 1:1061091981


Aicardi J: Aicardi syndrome. Brain Dev 27:1641712005


Al-Holou WNGarton HJMuraszko KMIbrahim MMaher CO: Prevalence of pineal cysts in children and young adults. Clinical article. J Neurosurg Pediatr 4:2302362009


Al-Holou WNMaher COMuraszko KMGarton HJ: The natural history of pineal cysts in children and young adults. Clinical article. J Neurosurg Pediatr 5:1621662010


Apuzzo MLDavey LMManuelidis EE: Pineal apoplexy associated with anticoagulant therapy. Case report. J Neurosurg 45:2232261976


Barboriak DPLee LProvenzale JM: Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol 176:7377432001


Bodensteiner JBSchaefer GBKeller GMMcConnell JR: Incidental pineal cysts in a prospectively ascertained normal cohort. Clin Pediatr (Phila) 35:2772791996


Carr JL: Cystic hydrops of the pineal gland. J Nerv Ment Dis 99:5525721944


Cauley KALinnell GJBraff SPFilippi CG: Serial follow-up MRI of indeterminate cystic lesions of the pineal region: experience at a rural tertiary care referral center. AJR Am J Roentgenol 193:5335372009


Cooper ER: The human pineal gland and pineal cysts. J Anat 67:28461932


Costa FFornari MValla PServello D: Symptomatic pineal cyst: case report and review of the literature. Minim Invasive Neurosurg 51:2312332008


Crystal SCRobbins MS: Epidemiology of tension-type headache. Curr Pain Headache Rep 14:4494542010


Cunningham Owens DGJohnstone ECBydder GMKreel L: Unsuspected organic disease in chronic schizophrenia demonstrated by computed tomography. J Neurol Neurosurg Psychiatry 43:106510691980


Dickerman RDStevens QESteide JASchneider SJ: Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis?. Neuroendocrinol Lett 25:1731752004


Di Costanzo ATedeschi GDi Salle FGolia FMorrone RBonavita V: Pineal cysts: an incidental MRI finding?. J Neurol Neurosurg Psychiatry 56:2072081993


Edwards MSHudgins RJWilson CBLevin VAWara WM: Pineal region tumors in children. J Neurosurg 68:6896971988


Fain JSTomlinson FHScheithauer BWParisi JEFletcher GPKelly PJ: Symptomatic glial cysts of the pineal gland. J Neurosurg 80:4544601994


Fakhran SEscott EJ: Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging?. AJNR Am J Neuroradiol 29:1591632008


Fetell MRBruce JNBurke AMCross DTTorres RAPowers JM: Non-neoplastic pineal cysts. Neurology 41:103410401991


Fleege MAMiller GMFletcher GPFain JSScheithauer BW: Benign glial cysts of the pineal gland: unusual imaging characteristics with histologic correlation. AJNR Am J Neuroradiol 15:1611661994


Franzese ABuongiovanni CBelfiore GMoggio GValerio GCiccarelli NP: Pineal cyst in a girl with central precocious puberty. Clin Pediatr (Phila) 36:5435451997


Golzarian JBalériaux DBank WOMatos CFlament-Durand J: Pineal cyst: normal or pathological?. Neuroradiology 35:2512531993


Gore PAGonzalez LFRekate HLNakaji P: Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Neurosurgery 62:3 Suppl 11081092008


Hanauer DA: EMERSE: The Electronic Medical Record Search Engine. AMIA Annu Symp Proc 2006:9412006


Hasegawa AOhtsubo KMori W: Pineal gland in old age; quantitative and qualitative morphological study of 168 human autopsy cases. Brain Res 409:3433491987


Jouvet AFauchon FBouffet ESaint-Pierre GChampier JMontange MFTumors of pineal parenchymal and glial cells. McLendon RERosenblum MKBigner DD: Russell and Rubinstein's Pathology of Tumors of the Nervous System ed 7LondonHodder Arnold2006. 413425


Karatza ECShields CLFlanders AEGonzalez MEShields JA: Pineal cyst simulating pinealoblastoma in 11 children with retinoblastoma. Arch Ophthalmol 124:5955972006


Kernick DCampbell J: Measuring the impact of headache in children: a critical review of the literature. Cephalalgia 29:3162009


Klein PRubinstein LJ: Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatry 52:9919951989


Koenigsberg RAFaro SMarino RTurz AGoldman W: Imaging of pineal apoplexy. Clin Imaging 20:91941996


Korogi YTakahashi MUshio Y: MRI of pineal region tumors. J Neurooncol 54:2512612001


Kumar KVVerma AModi KDRayudu BR: Precocious puberty and pineal cyst—an uncommon association. Indian Pediatr 47:1931942010


Lee DHNorman DNewton TH: MR imaging of pineal cysts. J Comput Assist Tomogr 11:5865901987


Lum GBWilliams JPMachen BCAkkaraju V: Benign cystic pineal lesions by magnetic resonance imaging. J Comput Tomogr 11:2282351987


Mamourian ACTowfighi J: Pineal cysts: MR imaging. AJNR Am J Neuroradiol 7:108110861986


Mandera MMarcol WBierzyńska-Macyszyn GKluczewska E: Pineal cysts in childhood. Childs Nerv Syst 19:7507552003


Maurer PKEcklund JParisi JEOndra S: Symptomatic pineal cyst: case report. Neurosurgery 27:4514541990


McNeely PDHowes WJMehta V: Pineal apoplexy: is it a facilitator for the development of pineal cysts?. Can J Neurol Sci 30:67712003


Mena HArmonda RARibas JLOndra SLRushing EJ: Nonneoplastic pineal cysts: a clinicopathologic study of twenty-one cases. Ann Diagn Pathol 1:11181997


Michielsen GBenoit YBaert EMeire FCaemaert J: Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien) 144:2332422002


Milroy CMSmith CL: Sudden death due to a glial cyst of the pineal gland. J Clin Pathol 49:2672691996


Molina-Martínez FJJiménez-Martínez MCVives-Pastor B: Some questions provoked by a chronic headache (with mixed migraine and cluster headache features) in a woman with a pineal cyst. Answers from a literature review. Cephalalgia 30:103110402010


Morgan JTScumpia AJWebster TMMittler MAEdelman MSchneider SJ: Resting tremor secondary to a pineal cyst: case report and review of the literature. Pediatr Neurosurg 44:2342382008


Mutlu FMAkin RUysal YUnay BAltinsoy HIBayraktar MZ: Aicardi syndrome: an unusual case associated with pineal gland cyst and ventricular septal defect. J Child Neurol 21:108210842006


Nimmagadda ASandberg DIRagheb J: Spontaneous involution of a large pineal region hemorrhagic cyst in an infant. Case report. J Neurosurg 104:4 Suppl2752782006


Oeckler RFeiden W: Benign symptomatic lesions of the pineal gland. Report of seven cases treated surgically. Acta Neurochir (Wien) 108:40441991


Osborn REDeen HGKerber CWGlass RF: A case of hemorrhagic pineal cyst: MR/CT correlation. Neuroradiology 31:1871891989


Pastel DAMamourian ACDuhaime AC: Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. Clinical article. J Neurosurg Pediatr 4:81842009


Patel AJFuller GNWildrick DMSawaya R: Pineal cyst apoplexy: case report and review of the literature. Neurosurgery 57:E10662005


Peres MFZukerman EPorto PPBrandt RA: Headaches and pineal cyst: a (more than) coincidental relationship?. Headache 44:9299302004


Petitcolin VGarcier JMMohammedi RRavel AMofid RViallet JF: [Prevalence and morphology of pineal cysts discovered at pituitary MRI: review of 1844 examinations.]. J Radiol 83:2 Pt 11411452002. (Fr)


Piatt JH Jr: Unexpected findings on brain and spine imaging in children. Pediatr Clin North Am 51:5075272004


Popovic MBDiezi MKuchler HAbouzeid HMaeder PBalmer A: Trilateral retinoblastoma with suprasellar tumor and associated pineal cyst. J Pediatr Hematol Oncol 29:53562007


Pu YMahankali SHou JLi JLancaster JLGao JH: High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR Am J Neuroradiol 28:170617092007


Richardson JKHirsch CS: Sudden, unexpected death due to “pineal apoplexy”. Am J Forensic Med Pathol 7:64681986


Robbins MSLipton RB: The epidemiology of primary headache disorders. Semin Neurol 30:1071192010


Rodjan Fde Graaf PMoll ACImhof SMVerbeke JISanchez E: Brain abnormalities on MR imaging in patients with retinoblastoma. AJNR Am J Neuroradiol 31:138513892010


Sarikaya-Seiwert STurowski BHänggi DJanssen GSteiger HJStummer W: Symptomatic intracystic hemorrhage in pineal cysts. Report of 3 cases. J Neurosurg Pediatr 4:1301362009


Sawamura YIkeda JOzawa MMinoshima YSaito HAbe H: Magnetic resonance images reveal a high incidence of asymptomatic pineal cysts in young women. Neurosurgery 37:11161995


Seifert CLWoeller AValet MZimmer CBerthele ATölle T: Headaches and pineal cyst: a case-control study. Headache 48:4484522008


Sener RN: The pineal gland: a comparative MR imaging study in children and adults with respect to normal anatomical variations and pineal cysts. Pediatr Radiol 25:2452481995


Stevens QEColen CBHam SDKattner KASood S: Delayed lateral rectus palsy following resection of a pineal cyst in sitting position: direct or indirect compressive phenomenon?. J Child Neurol 22:141114142007


Swaroop GRWhittle IR: Pineal apoplexy: an occurrence with no diagnostic clinicopathological features. Br J Neurosurg 12:2742761998


Tamaki NShirataki KLin TKMasumura MKatayama SMatsumoto S: Cysts of the pineal gland. A new clinical entity to be distinguished from tumors of the pineal region. Childs Nerv Syst 5:1721761989


Tapp EHuxley M: The histological appearance of the human pineal gland from puberty to old age. J Pathol 108:1371441972


Todo TKondo TShinoura NYamada R: Large cysts of the pineal gland: report of two cases. Neurosurgery 29:1011061991


Vaquero JMartínez REscandón JBravo G: Symptomatic glial cysts of the pineal gland. Surg Neurol 30:4684701988


Welton PLReicher MAKellerhouse LEOtt KH: MR of benign pineal cyst. AJNR Am J Neuroradiol 9:6121988


Wisoff JHEpstein F: Surgical management of symptomatic pineal cysts. J Neurosurg 77:8969001992




All Time Past Year Past 30 Days
Abstract Views 556 556 217
Full Text Views 1279 1279 105
PDF Downloads 477 477 29
EPUB Downloads 0 0 0


Google Scholar