Milton Camille K, Pelargos Panayiotis E, Dunn Ian F
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, United States.
Surg Neurol Int. 2020 Nov 11;11:384. doi: 10.25259/SNI_541_2020. eCollection 2020.
Pineal cysts are common entities, with a reported prevalence between 10 and 54%. Management of pineal cysts has historically been expectant, with surgical treatment of these lesions usually reserved for patients with a symptomatic presentation secondary to mass effect. The appropriate management of pineal cysts in patients presenting with headache in the absence of hydrocephalus - often the most common clinical scenario - has been more ambiguous. Here, we report the results of a comprehensive systematic review of headache outcomes for surgically treated, non-hydrocephalic pineal cyst patients without signs of increased intracranial pressure (ICP).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to construct a systematic review. A comprehensive search of the PubMed, Embase, Scopus, and Web of Science databases was conducted from through June 2020. Relevant English-language articles were identified using the search terms "pineal cyst" and "headache." The following eligibility criteria were applied: the inclusion of at least one surgically-treated, non-hydrocephalic pineal cyst patient presenting with headache in the absence of hemorrhage or signs and symptoms of increased ICP. Patient demographics and post-operative headache outcomes for the included studies were extracted and summarized.
A total of 24 pineal cyst cases meeting our selection criteria were identified across 11 included studies. Postoperative improvement or resolution of headaches was reported for 23/24 patients. Our systematic review of the literature demonstrates that non-hydrocephalic patients with pineal cysts have a high rate of headache improvement following surgical intervention.
The results indicate a need for further investigation of the link between headache and pineal cysts in the non-hydrocephalic patient.
松果体囊肿很常见，报告的患病率在10%至54%之间。松果体囊肿的治疗在历史上一直是观察等待，这些病变的手术治疗通常仅用于因占位效应而出现症状的患者。对于没有脑积水（这通常是最常见的临床情况）的头痛患者，松果体囊肿的适当治疗一直更不明确。在此，我们报告了对接受手术治疗、无脑积水且无颅内压升高（ICP）迹象的松果体囊肿患者头痛结局的全面系统评价结果。
遵循系统评价和Meta分析的首选报告项目指南进行系统评价。从建库至2020年6月对PubMed、Embase、Scopus和科学网数据库进行了全面检索。使用检索词“松果体囊肿”和“头痛”识别相关的英文文章。应用以下纳入标准：纳入至少一名接受手术治疗、无脑积水、无出血且无ICP升高迹象和症状的头痛松果体囊肿患者。提取并总结纳入研究的患者人口统计学资料和术后头痛结局。
在11项纳入研究中，共确定了24例符合我们选择标准的松果体囊肿病例。24例患者中有23例报告术后头痛改善或缓解。我们对文献的系统评价表明，无脑积水的松果体囊肿患者手术干预后头痛改善率很高。
结果表明需要进一步研究无脑积水患者头痛与松果体囊肿之间的联系。
