Pineal cyst related aqueductal stenosis as a cause of intractable headaches in non-hydrocephalic patients.
키워드
요약
BACKGROUND
Pineal cysts (PCs) are histologically benign lesions of the pineal gland. Although the majority of PCs are asymptomatic, some cases are ambiguous and accompanied by non-specific symptoms of variable severity. We suggested that disabling headache in non-hydrocephalic patients with PCs is associated with cerebral aqueduct (CAq) stenosis.
METHODS
A retrospective analysis was conducted in patients with PCs suffering from headache without secondary hydrocephalus who underwent surgical resection at Burdenko Neurosurgery Center between 1995 and 2016. All available medical records and radiographic images were retrospectively assessed in these patients. The comparison groups included 22 patients with non-operated PCs and 25 healthy individuals. The specific MRI measures were selected to assess morphometry of the CAq and the degree of the stenosis.
RESULTS
In Twenty-five patients (82%) we observed clinical improvement after surgery in a follow-up period. Among those with improvement, 10 (40%) experienced total relief and 15 (60%) - marked headache diminishment. In five patients headache remained persistent. The preoperative rostral CAq diameter appeared to be significantly more narrow (p = 0.0011045) and the preoperative rostral/caudal diameter ratio (Rd/Cd) was found to be lower (p = 0.004391) in patients who recovered from headache versus those who did not.
CONCLUSIONS
The results indicate a statistically significant relationship between the changes in the CAq morphometrics and the clinical outcome in postoperative period. Surgical removal of symptomatic pineal cysts in patients without hydrocephalus can be considered as an effective treatment. However, a thorough preoperative examination and patient selection should be conducted in every case.
