Guadix Sergio W, Marianayagam Neelan J, Weidman Elizabeth K, Yuan Melissa, Liechty Benjamin, Greenfield Jeffrey P, Souweidane Mark M
Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA.
Department of Radiology, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA.
Oper Neurosurg (Hagerstown). 2023 Jun 1;24(6):572-581. doi: 10.1227/ons.0000000000000620. Epub 2023 Jan 19.
Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk.
To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration.
Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed.
Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months).
The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.
神经影像学检查未发现脑积水可能会让松果体囊肿患者产生一种虚假的安全感。在本病例系列中，我们描述了一组松果体囊肿患者的隐匿性表现。这些患者的共同特征是阵发性头痛加重，提示间歇性梗阻性脑积水，以及第三脑室陷入的影像学证据，这表明他们属于高危患者。
明确隐匿性、高危松果体囊肿的特征以及内镜下囊肿开窗术的治疗效果。
回顾性分析2018年至2021年在我院接受内镜下囊肿开窗术的松果体囊肿患者的病历。为了找出隐匿性囊肿患者，如果在就诊时发现脑积水则将患者排除。回顾相关临床病史、影像学检查、手术数据和临床结果。
50例松果体囊肿患者中，4例符合纳入标准。所有患者均出现阵发性头痛加重。此外，75%（3/4）的患者还经历过间歇性晕厥。患者在纵向影像学检查中未出现脑积水（n = 3）或脑室大小波动（n = 1）。在所有病例中，高分辨率矢状位三维T2磁共振成像显示囊肿向前陷入第三脑室后部。所有患者均接受了内镜下囊肿开窗术，症状完全缓解（平均随访20.6个月；范围3.5 - 37.4个月）。
隐匿性、高危松果体囊肿的临床病史以阵发性头痛加重和意识发作性改变为特征提示间歇性梗阻性脑积水。由于在标准影像学检查中脑室大小可能看起来正常，临床怀疑应引发使用旨在检测这些囊肿的高分辨率磁共振成像进行检查。内镜下囊肿开窗术是一种安全有效的治疗策略。
