The natural history of pineal cysts in children and young adults

Clinical article

Restricted access


The authors reviewed their experience with pediatric pineal cysts to define the natural history and clinical relevance of this common intracranial finding.


The authors identified all patients with pineal cysts who had been clinically evaluated at their institution over an 11.5-year interval and were < 25 years of age at the time of diagnosis. All inclusion criteria were met in 106 patients, and included repeated MR imaging as well as repeated clinical evaluation over at least a 6-month interval.


The mean age at diagnosis was 11.7 ± 7.2 years. Forty-two patients were male and 64 were female. On follow-up MR imaging evaluation at a mean interval of 3.0 years from the initial study, 98 pineal cysts had no increase in size and no change in imaging appearance. Six pineal cysts increased in size and 2 others had a change in imaging characteristics without associated growth. Younger age was associated with cyst change or growth on follow-up imaging (p = 0.02). The mean age of patients with cysts that changed or grew was 5.5 years, and the mean age of patients with stable pineal cysts was 12.2 years. Initial cyst size and appearance on MR imaging were not significant predictors of growth or change in imaging appearance at follow-up. Similarly, the patient's sex was not a significant predictor of growth or change in imaging characteristics.


Follow-up imaging and neurosurgical evaluation may be considered optional in older children with pineal cysts.

Article Information

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

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Case 2. Sagittal (A) and axial (B) MR images obtained after Gd administration reveal a pineal cyst (see Table 1). Sagittal (C) and axial (D) images obtained at 2.9-year follow-up show interval enlargement of the cyst. This patient remains asymptomatic and no treatment has been recommended.

  • View in gallery

    Case 8. Sagittal (left) MR image showing what was initially diagnosed as a multiseptated pineal cyst (see Table 1). Sagittal (right) image obtained at 3.7-year follow-up showing definite interval enlargement of the cyst. This patient developed diplopia and underwent resection of the lesion. Histological findings were consistent with pineocytoma.

  • View in gallery

    Kaplan-Meier survival graph illustrating time to cyst change on neuroimaging. Cum = cumulative.



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


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


Carr JL: Cystic hydrops of the pineal gland. With a report of 6 cases. J Nerv Ment Dis 99:5525721944


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


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


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


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


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


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


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


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


Mandera MMarcol WBierzynska-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


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


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


Petitcolin VGarcier JMMohammedi RRavel AMofid RViallet JF: [Prevalence and morphology of pineal cysts discovered at pituitary MRI: review of 1844 examinations.]. J Radiol 83:1411452002. (Fr)


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


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


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


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


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


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




All Time Past Year Past 30 Days
Abstract Views 93 93 42
Full Text Views 66 66 14
PDF Downloads 81 81 12
EPUB Downloads 0 0 0


Google Scholar