Hvingelby Victor, Tsigka Eirini, Jensen Rigmor Hoejland, Hylin Sofia, Mathiesen Tiit
Department of Clinical Medicine-Nuclear Medicine and PET, Aarhus University, Aarhus, Denmark.
Department of Orthopedics, Svendborg Sygehus, Odense, Denmark.
Eur J Neurol. 2025 Mar;32(3):e70120. doi: 10.1111/ene.70120.
Pineal cysts are a frequent, potentially incidental finding in routine imaging studies. Their relationship with headache has been a matter of some controversy. In this prospective observational study, we sought to track the clinical and radiological trajectory of pineal cysts in both patients with and without concurrent headache.
A cohort study was conducted in patients referred to the Department of Neurosurgery at Karolinska Hospital for evaluation of a pineal cyst ≥ 5 mm between June 2005 and April 2017. Patients were stratified according to headache status and classified according to standard criteria. Development in cyst size and degree of aqueduct stenosis, as well as clinical progression of headache, was tracked.
157 cysts were identified (50 males and 107 females, mean age: 37 years), 103 of which were in patients primarily assessed for headaches. Cyst size remained stable over the follow-up period. There was no relationship between cyst size, the presence or progression of headache, nor with amenability to treatment. No relationship between the mass effect of the quadrigeminal plate and headache was observed. Of 13 patients treated with melatonin, 7 (53%) reported a subsequent decrease in headache severity.
A major proportion of seemingly incidental pineal cysts referred for neurosurgical evaluation were detected during work-up for headache. Furthermore, the size and symptoms associated with cysts remain stable over time, barring intervention. The therapeutic implications and relationship with other factors such as melatonin remain to be explored.
松果体囊肿在常规影像学检查中很常见，可能是偶然发现。它们与头痛的关系一直存在一些争议。在这项前瞻性观察研究中，我们试图追踪伴有和不伴有头痛的患者松果体囊肿的临床和影像学变化轨迹。
对2005年6月至2017年4月间转诊至卡罗林斯卡医院神经外科评估≥5毫米松果体囊肿的患者进行队列研究。患者根据头痛状况分层，并按照标准标准分类。追踪囊肿大小和导水管狭窄程度的变化以及头痛的临床进展情况。
共识别出157个囊肿（男性50例，女性107例，平均年龄：37岁），其中103个囊肿位于主要因头痛接受评估的患者中。在随访期间囊肿大小保持稳定。囊肿大小、头痛的存在或进展以及治疗的可行性之间均无关联。未观察到四叠体板的占位效应与头痛之间存在关联。在13例接受褪黑素治疗的患者中，7例（53%）报告随后头痛严重程度减轻。
在因头痛进行检查期间发现了很大一部分转诊至神经外科评估的看似偶然的松果体囊肿。此外，除非进行干预，囊肿的大小和相关症状随时间保持稳定。其治疗意义以及与褪黑素等其他因素的关系仍有待探索。
