Letter to the Editor:

Key words: arachnoid cyst, endoscopy, intracranial cyst, pineocytoma, intracranial tumor

We have read with interest the paper by Costa et al. [1] on the symptomatic pineal cysts and we congratulate the authors for bringing this topic to the attention of the readers of MIN.

Although most of the small pineal cysts are asymptomatic, some of them may cause symptoms that are not easily explained by the anatomic location of the lesion. We agree with the authors that most of the symptoms are non-specific and it is these non-specific symptoms that cause often a more conservative attitude to deal with these lesions, especially by the neurologists.

It is our experience, however that most of the non-specific symptoms can resolve after surgical resection of the pineal cyst, even in the situations in which no obstructive hydrocephalus is present and regardless the technique used to resect these lesions.

As an example, in January 2004 we have treated a 54-year-old woman who had had for more than 5 years complaints of headache, and paresthesias and numbness in the right hand. An MR imaging of the cervical spine revealed no abnormalities, and MR imaging of the brain showed a 1 cm large pineal lesion, regarded as a pineal cyst or a pinealocytoma.

The patient was kept for several years under conservative treatment by her neurologist who refused to refer her to a neurosurgeon for a second opinion. On request of the patient herself, she was seen in our department and it was decided to treat this lesion by an endoscope-assisted paramedian occipital mini-craniotomy and the lesion was marsupialized. Histological examination of the cyst wall showed a pinealocytoma.

The so far unexplained paresthesias and numbness in the right arm disappeared immediately following surgery and with a follow-up for almost 5 years, the patient remains symptom free. Serial MR imaging shows a small but stable remnant of the cyst.

Although this is just a case illustration, still it clearly shows that resolution of non-specific symptoms (not regarded as a consequence of the pineal lesion) can disappear after surgical treatment. During the last 15 years, we have treated more patients with unexplained symptoms that completely or partially disappeared after surgery.

In conclusion, it is our opinion that in patients with pineal lesions with persistent non-specific symptoms, a surgical treatment should be offered to and discussed with the patients.

References

• 1 Costa F, Fornari M, Valla P. et al . Symptomatic pineal cyst: Case report and review of literature.  Minim Invas Neurosurg. 2008;  51 231-233

Correspondence