Pinealcyst

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Pineal cysts are cysts of the pineal gland which is a small organ in the brain that produces melatonin (a sleep-regulating hormone). Pineal cysts are relatively common and may be found by chance in up to 10% of people undergoing CT or MRI brain imaging. The exact cause of pineal cysts is unknown. Most people with pineal cysts do not have any signs or symptoms.[1] Rarely, a pineal cyst may cause headaches, hydrocephalus, eye movement abnormalities, and Parinaud syndrome.[2] Treatment is usually only considered when a cyst is causing symptoms, in which case surgery, stereotactic aspiration or endoscopic treatment may be recommended.[3][4]

Symptoms

People with pineal cysts generally do not have any signs or symptoms. Occasionally, pineal cysts may cause headaches, hydrocephalus, disturbances in vision (gaze palsy), Parinaud syndrome, and vertigo, in which case they are called symptomatic pineal cysts.[5] Although rare, people with symptomatic pineal cysts may have other symptoms such as difficulty moving (ataxia); mental and emotional disturbances; seizures; sleep (circadian rhythm) troubles; hormonal imbalances that may cause precocious puberty; or secondary parkinsonism.[5]

Cause

The exact cause of pineal cysts is unknown. However, some studies suggest that bleeding in the pineal region or hormonal influences may play a role in the development and progression of pineal cysts.[5][6]

Treatment

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.[7] 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.[7]

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.[8][2]Treatment may include surgery to remove the cyst, sometimes followed by the placement of aventriculoperitoneal 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.[3] Radiation therapy may be recommended for cysts that recur after treatment.[7]

 

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.[9][10]  One study found that larger cysts were more likely to decrease in size over time[9], and there is currently no evidence that larger cysts are more likely to cause symptoms.[10]  

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.[4]  Some studies do not recommend repeated magnetic resonance imaging (MRI) of the cyst.[4]  Other studies state that repeated imaging of a pineal cyst is not required.[9]  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.[4][10]

Prognosis

The long-term outlook (prognosis) for people with pineal cysts is generally good. Most people are not severely affected by this condition and life expectancy is normal.[7]

Do you have updated information on this condition? Let us know.

Organizations

Nonprofit support and advocacy groups bring together patients, families, medical professionals, and researchers. These groups often raise awareness, provide support, and develop patient-centered information. Many are the driving force behind research for better treatments and possible cures. They can direct people to research, resources, and services. Many groups also have experts who serve as medical advisors. Visit their website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • The National Organization for Rare Disorders(NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

  • PubMedis a searchable database of medical literature and lists journal articles that discuss Pineal cyst. Click on the link to view a sample search on this topic.
  • My son was just diagnosed with having a pineal cyst which is multiseptate. I am concerned and want to know more. What causes it? What are the symptoms? Is it recommended to have it removed? See answer
  • I had an MRI three years ago and an incidental finding of a pineal cyst; it measured 14mm at that time. I had a second MRI recently and the cyst has not gotten bigger. I understand that 14 mm is pretty big by pineal cyst standards. Should I have another MRI or should I be concerned based on its size? See answer
  • My wife was diagnosed with a cyst on her pineal gland. We have been researching information and have seen both good and bad things. She’s had two MRIs and bloodwork done, and the doctors believe it’s benign. What else can we do? See answer
  • An MRI identified an unusual, one centimeter nodule on the edge of a pineal cyst.  How could this nodule be differentiated as a complicated pineal cyst or a pineocytoma?  What are the best treatment options for either a complicated pineal cyst or a pineocytoma if the patient is experiencing symptoms? See answer

References

  1. Fakhran S, Escott EJ. Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging?. American Journal of Neuroradiology. 2008; 29:159-163.http://www.ncbi.nlm.nih.gov/pubmed/17925371. Accessed 12/13/2011.
  2. Al-Holou WN, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults.  Neurosurg. Pediatrics. February 2010; 5(2):162-166.
  3. Costa F, Fornari M, Valla P, Servello D. Symptomatic Pineal Cyst: Case Report and Review of the Literature. Invas. Neurosurg.. 2008; 51:231-233.
  4. 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.
  5. Bosnjak J, Budisic M, Azman D, Strineka M, Crnjakovic M, Demarin V. Pineal gland cysts–an overview. Acta Clin Croat. September 2009; 48(3):355-358.
  6. Pineal Cysts, Symptomatic. NORD. October 2007; http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1146/viewFullReport. Accessed 11/13/2014.
  7. Maria Moschovi, MD; George P Chrousos, MD. Pineal Gland Masses. UpToDate. October 2013;
  8. 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.
  9. 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.
  10. 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.

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