Majovsky Martin, Benes Vladimir
Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenské nemocnice 1200, Prague 6, Czech Republic.
Chin Neurosurg J. 2018 Dec 11;4:33. doi: 10.1186/s41016-018-0142-7. eCollection 2018.
Pineal cysts (PCs) are a benign lesion of the pineal gland that have been known to the medical community for a long time. With a prevalence rate of approximately 1% in the general population, PC is often a reason for medical counseling. The natural course of PC morphology has not been well described. In this study, we present a longitudinal magnetic resonance imaging (MRI) study of patients with PCs, with special focus on those who showed an increase or decrease in PC size.
We enrolled all patients with a PC who were referred to our department between January 2000 and January 2018. Each patient underwent a clinical examination, and the patient's age, sex, and presenting signs and symptoms were noted. MRI was performed during periodic examinations, and a clinical and radiological course was reassessed.
In total, 133 patients (99 women, 34 men) were enrolled. The mean maximum diameter was 12.7 ± 5.2 mm (range 7-35 mm). PCs increased in size during the follow-up in seven patients (5.3%) and decreased in size in 10 (7.5%). The remaining cysts ( = 116, 87.2%) were stable over the follow-up period. Analyzing patients according to cyst size change, we found a significant difference in the mean age between the PC progression group and PC regression group ( = 0.01). The mean size of the PCs at the time of diagnosis did not differ significantly between the two groups ( = 0.81). We diagnosed two cases of pineal apoplexy.
We found that PCs are a dynamic structure that may change in size during the patient's lifetime. Patients with an increase in PC size were significantly younger than patients with a decrease in size. Therefore, PC growth in the first, second, and third decennium is normal and does not justify medical intervention. Surgery is indicated in cases of hydrocephalus and Parinaud's syndrome or in atypical cysts when neoplasia is suspected. The size of a PC does not predict PC behavior in terms of a future increase or decrease in size.
松果体囊肿（PCs）是松果体的一种良性病变，医学界对此已熟知已久。在普通人群中患病率约为1%，PCs常常是医学咨询的原因。PCs形态的自然病程尚未得到很好的描述。在本研究中，我们对患有PCs的患者进行了纵向磁共振成像（MRI）研究，特别关注那些PCs大小增加或减少的患者。
我们纳入了2000年1月至2018年1月期间转诊至我科的所有PCs患者。对每位患者进行临床检查，并记录患者的年龄、性别以及出现的体征和症状。在定期检查期间进行MRI检查，并重新评估临床和放射学病程。
共纳入133例患者（99例女性，34例男性）。平均最大直径为12.7±5.2毫米（范围7 - 35毫米）。7例患者（5.3%）的PCs在随访期间大小增加，10例患者（7.5%）的PCs大小减小。其余囊肿（n = 116，87.2%）在随访期间保持稳定。根据囊肿大小变化对患者进行分析，我们发现PCs进展组和PCs消退组的平均年龄存在显著差异（P = 0.01）。两组在诊断时PCs的平均大小无显著差异（P = 0.81）。我们诊断出2例松果体卒中。
我们发现PCs是一种动态结构，在患者一生中大小可能会发生变化。PCs大小增加的患者明显比大小减小的患者年轻。因此，在第一个、第二个和第三个十年中PCs的生长是正常的，无需医学干预。在脑积水和帕里诺德综合征的情况下或怀疑有肿瘤形成的非典型囊肿时，建议进行手术。PCs的大小并不能预测其未来大小增加或减少的行为。
