Department of Neurosurgery and Neurooncology, First Medical School, Charles University, Military University Hospital Prague, Prague, Czech Republic.
Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic.
J Neurol Surg A Cent Eur Neurosurg. 2022 Jan;83(1):31-38. doi: 10.1055/s-0041-1723813. Epub 2021 Jun 2.
Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature.
We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid-fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms "pineal" and "apoplexy."
Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy.
Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.
松果体卒中是一种罕见的疾病，其发病率和临床意义尚不清楚。为了阐明这种临床情况，我们分析了自己的病例系列，并对文献进行了回顾。
我们纳入了 2000 年 1 月至 2020 年 1 月期间我院收治的所有出血性松果体卒中患者。出血性松果体卒中定义为轴向或矢状磁共振扫描时松果体囊肿（PC）内存在液-液平面。在 1 例 PC 卒中患者中，我们进行了外周血褪黑素昼夜节律采样，以确定松果体的功能。我们在 PubMed 数据库中使用“松果体”和“卒中”这两个术语检索了文献。
共纳入 8 例患者，其中 3 例行手术治疗，5 例保守治疗。1 例患者进行了褪黑素昼夜分泌检测。结果证实了褪黑素的分泌具有保留的生理昼夜节律。我们对文献的检索共发现 31 项研究，包括 30 例 PC 卒中患者、9 例卒中性松果体肿瘤患者和 1 例正常松果体出血患者。大多数患者表现为头痛、恶心和呕吐，较少出现急性脑积水和眼球运动障碍。20 例 PC 患者行切除术或抽吸术。2 例患者仅行分流术，5 例行分流术联合手术切除。6 例 PC 患者观察治疗未行手术。9 例松果体肿瘤患者均行手术治疗。在有指征的情况下，4 例患者接受放疗，1 例患者接受化疗。
出血性松果体卒中的临床意义从无症状到迅速恶化和死亡不等。对于症状轻微的患者，建议观察，而对于出现梗阻性脑积水的严重病例，建议行手术治疗，包括脑脊液引流、卒中性松果体病变切除或两者兼施。
