spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy

Case Details

Disease Location

Pineal gland

Personal Characteristics

16 -year-old female, italian

Clinical Characteristics

Pineal cyst episodic headache that was unresponsive to treatment bilateral mild papillary edema a week before admission, decreased visual acuity MRI found cystic pineal mass with severe secondary obstructive hydrocephalus, the pineal mass lesion was 2.5 cm in diameter with a hypointense signal in t1-weighted images, the cyst wall enhanced moderately after contrast, signal intensity didn't increase suggesting a benign cyst tumor makers were negative in both serum and csf postoperative MRI showed the patency of the artificially induced communication between the floor of the third ventricle and the premesencephalic cistern and the persistence of the pineal cyst which increased size compared to pre-op

Remission Characteristics

After the endoscopic third-ventriculostomy nearly immediately resolved the headaches 6 months later, MRI found the ventricular system and the cyst reduced in size, after another 6 months, MRI confirmed normalization of the ventricles and reduced cyst size. 1 year later, MRI showed complete normalization in volume and shape of ventricular system and significant reduction in size of the pineal cystic lesion. 3 years after the operation the cyst was barely recognizable in MRI

Treatment & Mechanisms

Proposed Remission Mechanisms

A third-ventriculostomy with subsequent normalization of intraventricular pressure through displacement of fluid from the cystic cavity into the third ventricle

Clinical Treatment

An endoscopic third-ventriculostomy shunting of hydrocephalus

Non-Clinical Treatment

None reported