Systematic review of pineal cysts surgery in pediatric patients

Childs Nerv Syst. 2020 Dec;36(12):2927-2938. doi: 10.1007/s00381-020-04792-3. Epub 2020 Jul 20.


Introduction: We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments.

Methods: The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles.

Results: The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001).

Conclusions: Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures.

Keywords: Microneurosurgery; Pineal cysts; Sitting position; Supracerebellar infratentorial approach.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Brain Neoplasms* / surgery
  • Central Nervous System Cysts* / complications
  • Central Nervous System Cysts* / diagnostic imaging
  • Central Nervous System Cysts* / surgery
  • Child
  • Cysts* / diagnostic imaging
  • Cysts* / surgery
  • Female
  • Humans
  • Male
  • Microsurgery
  • Pineal Gland* / diagnostic imaging
  • Pineal Gland* / surgery