David I Pitskhelauri1, Alexander N Konovalov1, Irakliy T Abramov2, Gleb V Danilov1, Igor N Pronin3, Evgeniya V Alexandrova4, Nataliya K Serova5, Alexander Z Sanikidze1. 1. Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. 2. Department of Neurooncology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. Electronic address: irakliyabramov@gmail.com. 3. Department of Neuroradiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. 4. Department of Neurology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. 5. Department of Neuroopththalmology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
Abstract
BACKGROUND: Pineal cysts (PCs) are histologically benign lesions of the pineal gland. Although the majority of PCs are asymptomatic, some cases are ambiguous and accompanied by nonspecific symptoms of variable severity. We suggested that disabling headache in nonhydrocephalic patients with PCs is associated with cerebral aqueduct (CAq) stenosis. METHODS: A retrospective analysis was conducted in patients with PCs suffering from headache without secondary hydrocephalus who underwent surgical resection at Burdenko Neurosurgery Center between 1995 and 2016. All available medical records and radiographic images were retrospectively assessed in these patients. The comparison groups included 22 patients with nonoperated PCs and 25 healthy individuals. Specific magnetic resonance imaging measures were selected to assess the morphometry of the CAq and degree of the stenosis. RESULTS: In 25 patients (82%) we observed clinical improvement after surgery in a follow-up period. Among those with improvement, 10 of them (40%) experienced total relief and 15 of them (60%) had marked headache diminishment. In 5 patients the headache remained persistent. The preoperative rostral CAq diameter appeared to be significantly narrower (P = 0.0011045), and the preoperative rostral/caudal diameter ratio (Rd/Cd) was found to be lower (P = 0.004391) in patients who recovered from headache versus those who did not. CONCLUSION: The results indicate a statistically significant relationship between the changes in the CAq morphometrics and the clinical outcome in postoperative period. Surgical removal of symptomatic pineal cysts in patients without hydrocephalus can be considered as an effective treatment. However, a thorough preoperative examination and patient selection should be conducted in every case.
BACKGROUND: Pineal cysts (PCs) are histologically benign lesions of the pineal gland. Although the majority of PCs are asymptomatic, some cases are ambiguous and accompanied by nonspecific symptoms of variable severity. We suggested that disabling headache in nonhydrocephalic patients with PCs is associated with cerebral aqueduct (CAq) stenosis. METHODS: A retrospective analysis was conducted in patients with PCs suffering from headache without secondary hydrocephalus who underwent surgical resection at Burdenko Neurosurgery Center between 1995 and 2016. All available medical records and radiographic images were retrospectively assessed in these patients. The comparison groups included 22 patients with nonoperated PCs and 25 healthy individuals. Specific magnetic resonance imaging measures were selected to assess the morphometry of the CAq and degree of the stenosis. RESULTS: In 25 patients (82%) we observed clinical improvement after surgery in a follow-up period. Among those with improvement, 10 of them (40%) experienced total relief and 15 of them (60%) had marked headache diminishment. In 5 patients the headache remained persistent. The preoperative rostral CAq diameter appeared to be significantly narrower (P = 0.0011045), and the preoperative rostral/caudal diameter ratio (Rd/Cd) was found to be lower (P = 0.004391) in patients who recovered from headache versus those who did not. CONCLUSION: The results indicate a statistically significant relationship between the changes in the CAq morphometrics and the clinical outcome in postoperative period. Surgical removal of symptomatic pineal cysts in patients without hydrocephalus can be considered as an effective treatment. However, a thorough preoperative examination and patient selection should be conducted in every case.
Authors: Steffen Fleck; Ahmed El Damaty; Ina Lange; Marc Matthes; Ehab El Rafaee; Sascha Marx; Jörg Baldauf; Henry W S Schroeder Journal: Neurosurg Rev Date: 2022-07-12 Impact factor: 2.800
Authors: Joham Choque-Velasquez; Julio C Resendiz-Nieves; Szymon Baluszek; Roberto Colasanti; Sajjad Muhammad; Juha Hernesniemi Journal: Surg Neurol Int Date: 2020-10-29