Pinealiszysten und drei operative Strategien: klinisches und morphologisches Ergebnis

To assess the outcome of different surgical treatment strategies for symptomatic pineal gland cysts and its correlation with preoperative symptoms and cyst morphology.

A retrospective analysis of 18 patients who underwent surgery for symptomatic pineal gland cysts between 2008 and 2023 was conducted. Three surgical approaches were used: microsurgical resection (n=12), endoscopic fenestration (n=3), and stereotactic Rickham catheter placement (n=3). Preoperative MRI measurements included cyst size, growth tendency, and relationships with surrounding structures. Clinical outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at 3 months, 12 months, and at long-term follow-up.

Headache was the predominant symptom (17/18), followed by visual disturbances (6/18), and vertigo (5/18). Hydrocephalus was present in 5 cases. Surgery indications included symptom severity (n=9), suspected malignancy (n=6), cyst growth (n=2), and hydrocephalus (n=5). At 3-month follow-up, 90% of patients showed good or excellent results (CCOS≥12), with 85% maintaining improvement at 12 months. After a mean follow-up of 53 months, 87% of patients reported good or excellent outcomes. One complication occurred in the microsurgical group (cerebellar edema with hydrocephalus), and no mortality was observed. Microsurgical resection was more commonly preferred for cases with suspected malignancy, endoscopic fenestration for hydrocephalus with anterior cyst growth, and stereotactic approaches for smaller cysts with low growth tendency.

All three surgical approaches demonstrated effectiveness in treating symptomatic pineal gland cysts, with high rates of symptom improvement. Surgical strategy selection may be individualized based on cyst morphology, growth pattern, and presenting symptoms.