ArticleActa neurochirurgica2026
Pineal cyst surgery beyond morphology: a critical evaluation of a consecutive surgical series.
Article in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe surgical management of pineal cysts (PC) remains controversial, particularly in non-hydrocephalic patients where radiological and clinical correlations are inconsistent. Most studies rely on cyst size or morphology as surgical criteria. This study aims to assess clinical-radiological correlations and outcomes in a consecutive single-center cohort, and to compare outcomes across microsurgical, endoscopic, and stereotactic approaches.
methodsA retrospective analysis was performed on 46 symptomatic PC patients treated between 2008 and 2024. Clinical data and radiological data, including cyst dimensions, third ventricle-mesencephalic angle, aqueduct diameter, and predominant expansion were analyzed. Patients were categorized into surgical (n = 18) and non-surgical (n = 28) cohorts. Surgical outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at 3-month, 12-month, and long-term follow-up. Statistical comparisons were conducted to correlate radiological markers with symptoms and postoperative outcomes.
resultsHeadache was the most common symptom in both groups (80%), followed by visual disturbances in the surgical group (33%), and vertigo in the non-surgical group (32%). Compared with the non-surgical cohort, the surgical patients had larger cysts, narrower aqueducts (0.9 vs. 1.6 mm, p < 0.001) and a higher prevalence of predominant anterior expansion (67% vs. 7%, p < 0.001). Among all operated patients, 94% achieved good or excellent CCOS outcomes at 12-months, and 93% maintained these outcomes at long-term follow-up (mean 62 months, range 16-216 months). Neither PC volume nor hydrocephalus predicted consistently postoperative outcome. Microsurgical resection (n = 12) achieved favorable long-term outcome (mean CCOS 14.9), but the highest complication rate (3 patients) and the highest recurrence of headache despite total PC excision. Endoscopic fenestration with ventriculostomy (n = 3) yielded the best long-term outcome (mean CCOS 15.7) with no recurrences. Stereotactic drainage with a catheter with a Rickham reservoir placement (n = 3) provided stable decompression but lower CCOS scores at long-term (mean CCOS 13.0) compared with other approaches.
conclusionSurgery for symptomatic PC provides durable improvement when guided by radiological-clinical criteria. Aqueduct diameter was more closely associated with outcome than PC size. Microsurgical, endoscopic, and stereotactic approaches each have specific roles that should guide individualized treatment.
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