Large glial cyst of the pineal gland: a possible growth mechanism

Case report

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✓ The authors report on a patient who presented with a large symptomatic glial cyst of the pineal gland communicating with the third ventricle. The hole between the ventricle and the cyst, suspected on magnetic resonance images, was found at surgery. The to-and-fro flow mechanism is considered to be involved in the pathogenesis of growth in this unusual large glial cyst of the pineal gland, although this mechanism cannot be applied universally.

Article Information

Address reprint requests to: Dong Gyu Kim, M.D., Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110–744, Korea.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial CT scan showing a cystic mass in the pineal region with a calcification in the central to right side of the cyst's anterior wall. Dilated ventricles may also be noted.

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    Left: Sagittal T1-weighted MR image (TR 440 msec/TE 12 msec) showing a well-demarcated cystic mass in the pineal region with obstructive hydrocephalus. Center: Sagittal T2-weighted MR image (TR 4000 msec/TE 99 msec) showing inhomogeneous signal intensities (arrowheads) in the cyst, thought to be caused by turbulent flow between the cyst and the third ventricle. In addition, low signal intensity seen between the cyst and the third ventricle (arrow) may be the route of communication between the two through the left side of the cyst's anterior wall, which is distant from the calcification shown on the CT scan. Right: Axial fluid-attenuated inversion recovery MR image (TR 10,000 msec/TE 21 msec) demonstrating more clearly the possible route of communication between the cyst and the third ventricle (arrow).

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    Intraoperative photograph showing a hole (curved arrow), through the fenestrated posterior wall, in the anterior wall of the cyst, allowing communication with the third ventricle.

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