Di Chirico A, Di Rocco F, Velardi F
Section of Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy.
Childs Nerv Syst. 2001 Jan;17(1-2):42-6. doi: 10.1007/pl00013724.
With the advent of modern diagnostic tools for neuroimaging, the incidental detection of pineal cysts in asymptomatic subjects has increased. Only rarely do pineal cysts present with the clinical signs and symptoms of increased intracranial pressure or with neurological deficits in relation to compression and distortion of the adjacent nervous structures and cerebrospinal fluid pathways. While asymptomatic cysts are considered to be normal variants for which no further investigations are usually required, surgical treatment is suggested for symptomatic cysts, with the goal of eliminating the block in the cerebrospinal fluid circulation and/or the mass effect exerted by the lesion. In this report we describe a pediatric case of symptomatic pineal cyst, revealed by repeated episodes of headache caused by secondary obstructive hydrocephalus. Following an endoscopic third-ventriculostomy, serial magnetic resonance imaging studies demonstrated that not only had the ventriculomegaly resolved but also that the pineal cyst had regressed over time. A to-and-fro movement of fluid through the cyst wall, the direction of which depends on the equilibrium existing between the inner pressure of the cyst and the outer cerebrospinal fluid pressure, is suggested as a possible mechanism accounting for this unexpected result--to our knowledge, the first reported in literature.
随着现代神经影像学诊断工具的出现，无症状受试者中松果体囊肿的偶然发现有所增加。松果体囊肿很少出现颅内压升高的临床体征和症状，或因邻近神经结构和脑脊液通路受压和变形而出现神经功能缺损。虽然无症状囊肿被认为是正常变异，通常无需进一步检查，但对于有症状的囊肿建议进行手术治疗，目的是消除脑脊液循环阻塞和/或病变产生的占位效应。在本报告中，我们描述了一例有症状的松果体囊肿的儿科病例，该病例由继发性梗阻性脑积水引起的反复头痛所揭示。在内镜下第三脑室造瘘术后，系列磁共振成像研究表明，不仅脑室扩大得到缓解，而且松果体囊肿也随时间推移而缩小。囊肿壁上液体的来回流动，其方向取决于囊肿内压与外部脑脊液压力之间的平衡，这被认为是解释这一意外结果的一种可能机制——据我们所知，这是文献中首次报道。
