Prevalence and natural history of pineal cysts in adults

Clinical article

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Object

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

Methods

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.

Results

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.

Conclusions

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: cmaher@med.umich.edu.

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.

Headings

Figures

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    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.

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