Pineal cysts without hydrocephalus: Microsurgical resection via an infratentorial-supracerebellar approach – Surgical strategies, complications and their avoidance – How we do it.

Abstract Introduction Indications for surgery of pineal cysts without ventriculomegaly are still under debate. In view of the limited data for pineal cyst resection in the absence of hydrocephalus, and the potential risk of this approach, we have analysed our patient cohort focussing on strategies to avoid complications according to our experience in a series of 73 pineal cyst patients. MethodsFrom 2003 to 2015, we reviewed our database retrospectively for all patients operated on a pineal cyst. Furthermore, we prospectively collected patients from 2016 to 2020. In summary, 73 patients with a pineal cyst were treated surgically between 2003 and 2020. All patients were operated on via a microscopic supracerebellar-infratentorial (SCIT) approach. The mean follow-up period was 26.6 months (range: 6-139 months).Results73 patients underwent surgery for a pineal cyst. An absence of enlarged ventricles was documented in 62 patients (51 female, 11 male, mean age 27.67 yrs). Main presenting symptoms included headache, visual disturbances, dizziness/vertigo, nausea/emesis, sleep disturbances. Complete cyst resection was achieved in 59/62 patients. 55 of 62 (89%) patients improved after surgery with good or even excellent results according to the Chicago Chiari Outcome Scale, with complete or partial resolution of the leading symptoms.ConclusionPineal cysts resection might be an indication in certain patients for surgery even in the absence of ventriculomegaly. The high percentage of postoperative resolution of quality-of-life impairing symptoms in our series seems to justify surgery. Preoperatively, other causes of the leading symptoms have to be excluded.