Fact-sheet: Pineal cyst
Updated on 09/17/2021 at 12:16 PM
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Definition
Benign pineal gland cyst Population: Young woman
Clinical features
Most often asymptomatic (incidental finding).
Rarely:
- acute supratentorial hydrocephalus due to compression of the aqueduct of Sylvius
- headaches related to hemorrhagic changes.
- Parinaud syndrome due to compression of the tectal plate
Laboratory findings
normal
CT
Isodense lesion of the pineal gland, round or oval, well-defined, located posterior to the tectal plate or between the internal cerebral veins.
Calcification of the cyst wall in approximately 25% of cases
Hyperdensity if hemorrhagic changes are present.
Size usually <10mm but may measure more than 20mm.
MRI
T1: Homogeneous hyperintensity in 55-60% of cases. Isointensity in 40% of cases. Homogeneous hyperintensity in cases of hemorrhagic changes T2 FSE: iso- or hyperintense T2 FLAIR: Moderate hyperintensity T2*: isointense or hypointense if hemorrhagic changes are present T1 post-gadolinium: partial enhancement of the walls in 60% of cases Diffusion: no restriction of ADC
Management
Watchful waiting in most cases
Cyst drainage or resection via an infratentorial supracerebellar approach in symptomatic cases.
Shunting if hydrocephalus is present.
Differential diagnosis
Normal pineal gland
Pineocytoma: larger solid component. Sometimes only biopsy allows the diagnosis to be made
Epidermoïd cyst: less regular, diffusion hyperintensity
Arachnoid cyst: no wall calcification or enhancement. More fluid-like signal