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Hasegawa H, Inoue A, Helal A, Kashiwabara K, Meyer FB. Pineal cyst: results of long-term MRI surveillance and analysis of growth and shrinkage rates. J Neurosurg 2023; 138:113-119. [PMID: 35623363 DOI: 10.3171/2022.4.jns22276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/12/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Pineal cyst (PC) is a relatively common true cyst in the pineal gland. Its long-term natural course remains ill defined. This study aims to evaluate the long-term natural history of PC and examine MRI risk factors for cyst growth and shrinkage to help better define which patients might benefit from surgical intervention. METHODS The records and MRI of 409 consecutive patients with PC were retrospectively examined (nonsurgical cohort). Cyst growth and shrinkage were defined as a ≥ 2-mm increase and decrease in cyst diameter in any direction, respectively. In addition to size, MRI signal intensity ratios were analyzed. RESULTS The median radiological follow-up period was 10.7 years (interquartile range [IQR] 6.4-14.3 years). The median change in maximal diameter was -0.6 mm (IQR -1.5 to 1.3 mm). During the observation period, cyst growth was confirmed in 21 patients (5.1%). Multivariate logistic regression analysis revealed that only age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99, p < 0.01) was significantly associated with cyst growth. No patient required resection during the observation period. Cyst shrinkage was confirmed in 57 patients (13.9%). Multivariate analysis revealed that maximal diameter (OR 1.22, 95% CI 1.12-1.35, p < 0.01) and cyst CSF T2 signal intensity ratio (OR 9.06, 95% CI 1.38-6.62 × 101, p = 0.02) were significantly associated with cyst shrinkage. CONCLUSIONS Only 5% of PCs, mainly in patients younger than 50 years of age, have the potential to grow, while cyst shrinkage is more likely to occur across all age groups. Younger age is associated with cyst growth, while larger diameter and higher signal intensity on T2-weighted imaging are associated with shrinkage. Surgery is rarely needed for PCs, despite the possibility of a certain degree of growth.
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Affiliation(s)
- Hirotaka Hasegawa
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Akitoshi Inoue
- 3Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
| | - Ahmed Helal
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kosuke Kashiwabara
- 4Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Japan
| | - Fredric B Meyer
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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2
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Fava D, Calandrino A, Calevo MG, Allegri AEM, Napoli F, Gastaldi R, Patti G, Casalini E, Bassi M, Accogli A, Alyasin ARAA, Ramaglia A, Rossi A, Maghnie M, Morana G, Di Iorgi N. Clinical, Endocrine and Neuroimaging Findings in Girls With Central Precocious Puberty. J Clin Endocrinol Metab 2022; 107:e4132-e4143. [PMID: 35881919 DOI: 10.1210/clinem/dgac422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The etiology of central precocious puberty (CPP) includes a spectrum of conditions. Girls younger than age 6 years with CPP should undergo cranial magnetic resonance imaging (MRI), but it remains controversial whether all girls who develop CPP between the ages of 6 and 8 years require neuroimaging examination. OBJECTIVE To investigate the frequency of brain MRI abnormalities in girls diagnosed with CPP and the relationship between maternal factors, their age at presentation, clinical signs and symptoms, hormonal profiles, and neuroimaging findings. METHODS Data were collected between January 2005 and September 2019 from 112 girls who showed clinical pubertal progression before 8 years of age who underwent brain MRI. RESULTS MRI was normal in 47 (42%) idiopathic (I) scans, 54 (48%) patients had hypothalamic-pituitary anomalies (HPA) and/or extra-HP anomalies (EHPA), and 11 (10%) had brain tumors or tumor-like conditions (BT/TL), including 3 with neurological signs. Associated preexisting disorders were documented in 16. Girls with BT/TL had a higher LH peak after GnRH test (P = 0.01) than I, and those older than age 6 years had a higher craniocaudal diameter of the pituitary gland (P = 0.01); their baseline FSH and LH (P = 0.004) and peak FSH (P = 0.01) and LH (P = 0.05) values were higher than I. Logistic regression showed maternal age at menarche (P = 0.02) and peak FSH (P = 0.02) as BT/TL risk factors. CONCLUSIONS MRI provides valuable information in girls with CPP by demonstrating that fewer than half have a normal brain MRI and that few can have significant intracranial lesions after the age of 6, despite the absence of suggestive neurological signs.
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Affiliation(s)
- Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Calandrino
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | | | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Emilio Casalini
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Accogli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal H4A 3J1, Canada
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal H3A 1G1, Canada
| | - Abdel Razaq Ahmad A Alyasin
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa 16142, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin 10126, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
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Konovalov A, Pitskhelauri D, Serova N, Shishkina L, Abramov I. Pineal cyst management: A single-institution experience spanning two decades. Surg Neurol Int 2022; 13:350. [PMID: 36128100 PMCID: PMC9479525 DOI: 10.25259/sni_130_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Pineal cysts (PCs) are benign lesions commonly found on intracranial imaging. Despite their high prevalence, there is no clear consensus on the most appropriate management of patients with PCs, especially those with symptomatic nonhydrocephalic cysts. Methods: A retrospective analysis was performed on 142 patients with PCs (103 surgical cases and 39 conservatively managed cases). Data were examined, including clinical presentation, imaging findings, ophthalmological status, natural course, postoperative outcomes, and complications. Results: Surgical group: the most common symptom was headache (92%), followed by signs of intracranial hypertension due to hydrocephalus (22%). New radiological feature of PCs was found in 11 patients. From 71 patients with long-term follow-up, headache completely resolved in 44 (62%) patients; marked improvement was observed in 20 (29%); in 7 (9%) – headache remained unchanged. The most common postoperative complication was neuro-ophthalmological disorders (23%), with a tendency for resolution in the long-term follow-up period. Neuro-ophthalmological symptoms at last follow-up included upward gaze palsy (6%) and skew deviation (5%), followed by convergence disorders (3%) and eyelid-retraction (2%). Natural course group: PC size remained stable in 34 (87%) patients during the follow-up period. The patient’s gender or age was not a significant predictor of cyst growth (P = 0.4, P = 0.56). Conclusion: The majority of patients with a newly diagnosed PC remain clinically and radiologically stable. Patients with nonhydrocephalic PCs and intractable headaches experience significant relief in headache symptoms, but are at risk of mild to moderate neuro-ophthalmological disorders. The natural course of PCs and factors promoting their growth still remains poorly defined.
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Affiliation(s)
- Alexander Konovalov
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - David Pitskhelauri
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Natalia Serova
- Department of Neuro-Ophthalmology, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Lyudmila Shishkina
- Department of Neuropathology, Burdenko Neurosurgery Center, Moscow, Russian Federation
| | - Irakliy Abramov
- Department of Neurosurgery, Burdenko Neurosurgery Center, Moscow, Russian Federation
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4
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Filippo GD, Gaudino R, Calcaterra V, Villani A, Bozzola E, Bozzola M. Incidental pineal gland cyst in girls with early onset of puberty. Ital J Pediatr 2022; 48:44. [PMID: 35313951 PMCID: PMC8935686 DOI: 10.1186/s13052-022-01235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background The causes of an early onset of puberty are still not clearly defined and may vary from subject to subject. In girls, even if 90% of early puberty is idiopathic, magnetic resonance imaging (MRI) of the brain is performed to exclude secondary causes of precocious puberty, in particular pathological lesions as hypothalamic tumours (hamartoma). In some cases, other intracranial lesions are considered as incidental findings. Aim of the study is evaluating the prevalence of abnormal intracranial lesions detected by brain magnetic resonance imaging MRI with particular focus on the prevalence of pineal gland cysts in the diagnostic work-up of girls with central precocious puberty (CPP) as onset before 8 years and central early puberty (CEP) as onset before 10 years. Material and methods MRI data of girls referred from January 2010 to December 2015 to the Pediatric Endocrinology Unit of University of Pavia for early onset of breast development were collected. Results We collected 123 MRI data of girls referred to the Pediatric Endocrinology Unit of University of Pavia for early onset of breast development in the study period. Out of them, 25 (20.3%) had cerebral abnormalities and 15 (12.2%) had pineal gland cysts. No significant differences were noted in auxological, ultrasound and hormonal parameters at diagnosis among girls with or without pineal cysts. Patients have been observed for at least three years after the discontinuation of therapy. None of our patients had an unfavorable evolution. Conclusions Although pineal cysts seem to be not involved in the onset of puberty, the relevance of the finding remains controversial. Our study wants to provide further insight into the incidence of pineal cysts in pubertal advances. Of note, pineal cysts are often asymptomatic and do not evolve over time.
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Cattoni A, Albanese A. Case report: Fluctuating tumor markers in a boy with gonadotropin-releasing hormone-independent precocious puberty induced by a pineal germ cell tumor. Front Pediatr 2022; 10:940656. [PMID: 36081625 PMCID: PMC9445167 DOI: 10.3389/fped.2022.940656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
GnRH-independent precocious puberty (GIPP) can be the presenting clinical picture experienced by patients with secreting germ cell tumor (GCT). Indeed, as luteinizing hormone (LH) and human chorionic gonadotropin (hCG) share identical α-subunits and similar β-subunits, an increased secretion of β-hCG may result in a precocious activation of Leydig cells. Though the co-occurrence of raised β-hCG levels and signs of precocious virilization usually prompts a complete oncological work-up, the diagnostic and therapeutic management of GCT-induced GIPP may be challenging. We report the case of a 6.2 year-old boy presenting with clinical and biochemical findings consistent with GIPP (discrepancy between overt virilization and pre-pubertal testicular volume, suppressed gonadotropins and remarkably raised testosterone). Brain imaging detected a bilobed cyst of the pineal gland, while serum and cerebrospinal baseline assessment initially ruled out raised alpha-fetoprotein or β-hCG levels. Nevertheless, a strict biochemical follow-up highlighted a fluctuant trend of tumor markers, with a more aggressive behavior and recurrent erections occurring as a result of unpredictable phases of raised testosterone and serum/cerebrospinal β-hCG, followed by sudden spontaneous decrease. Accordingly, a secreting pineal GCT was suspected. Given the fluctuating trend of tumor markers, surgery was initially kept on hold and a combined treatment with bicalutamide (androgen receptor blocker) and anastrozole (aromatase inhibitor) was undertaken in order to prevent the patient from experiencing further virilization and excessive bone age maturation. Subsequently, a progression in the size of the pineal tumor prompted surgical resection and a diagnosis of secreting GCT was histologically confirmed. Accordingly, the patient was started on adjuvant chemo- and radiotherapy. Antineoplastic treatment was followed by persistent and remarkable decrease of tumor markers and by a complete pubertal arrest. We reported the challenging diagnosis of a secreting pineal GCT in a patient with GIPP and a fluctuating trend of tumor markers, testosterone levels and associated clinical signs, hence prompting the indication for a systematic assessment and a strict monitoring whenever a patient with GnRH-independent precocious puberty shows clinical or radiological markers potentially consistent with a GCT.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, The Royal Marsden NHS Foundation Trust, London, United Kingdom.,Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Assunta Albanese
- Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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6
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Zaccagna F, Brown FS, Allinson KSJ, Devadass A, Kapadia A, Massoud TF, Matys T. In and around the pineal gland: a neuroimaging review. Clin Radiol 2021; 77:e107-e119. [PMID: 34774298 DOI: 10.1016/j.crad.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/30/2021] [Indexed: 01/16/2023]
Abstract
Lesions arising in or around the pineal gland comprise a heterogeneous group of pathologies ranging from benign non-neoplastic cysts to highly malignant neoplasms. Pineal cysts are frequently encountered as an incidental finding in daily radiology practice but there is no universal agreement on the criteria for, frequency of, and duration of follow-up imaging. Solid pineal neoplasms pose a diagnostic challenge owing to considerable overlap in their imaging characteristics, although a combination of radiological appearances, clinical findings, and tumour markers allows for narrowing of the differential diagnosis. In this review, we describe the radiological anatomy of the pineal region, clinical symptoms, imaging appearances, and differential diagnosis of lesions arising in this area, and highlight the clinical management of these conditions.
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Affiliation(s)
- F Zaccagna
- Department of Radiology, University of Cambridge, Cambridge, UK; Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - F S Brown
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - K S J Allinson
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Devadass
- Department of Pathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A Kapadia
- Division of Neuroimaging, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - T F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - T Matys
- Department of Radiology, University of Cambridge, Cambridge, UK.
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7
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Baldo F, Marin M, Murru FM, Barbi E, Tornese G. Dealing With Brain MRI Findings in Pediatric Patients With Endocrinological Conditions: Less Is More? Front Endocrinol (Lausanne) 2021; 12:780763. [PMID: 35095759 PMCID: PMC8791386 DOI: 10.3389/fendo.2021.780763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/20/2021] [Indexed: 12/22/2022] Open
Abstract
Neuroimaging is a key tool in the diagnostic process of various clinical conditions, especially in pediatric endocrinology. Thanks to continuous and remarkable technological developments, magnetic resonance imaging can precisely characterize numerous structural brain anomalies, including the pituitary gland and hypothalamus. Sometimes the use of radiological exams might become excessive and even disproportionate to the patients' medical needs, especially regarding the incidental findings, the so-called "incidentalomas". This unclarity is due to the absence of well-defined pediatric guidelines for managing and following these radiological findings. We review and summarize some indications on how to, and even if to, monitor these anomalies over time to avoid unnecessary, expensive, and time-consuming investigations and to encourage a more appropriate follow-up of brain MRI anomalies in the pediatric population with endocrinological conditions.
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Affiliation(s)
| | - Maura Marin
- University of Trieste, Trieste, Italy
- *Correspondence: Maura Marin,
| | - Flora Maria Murru
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
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Brener A, Kozyrev DA, Shiran SI, Azoulay E, Pratt LT, Precel R, Ben-Sira L, Eyal O, Constantini S, Roth J, Lebenthal Y. Incidental Findings on Brain Magnetic Resonance Imaging (MRI) in Pediatric Endocrine Patients. Endocr Pract 2020; 26:1105-1114. [PMID: 33471712 DOI: 10.4158/ep-2020-0208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/10/2020] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To explore incidental findings on brain magnetic resonance imaging (MRI) studies of pediatric patients referred due to endocrine disorders. METHODS A retrospective, observational study conducted in a tertiary referral center. The neuroimaging database of 17,445 brain MRI studies of 11,011 pediatric patients were searched for cases with endocrine referrals and without medical history of malignancy, genetic syndromes, and/or neurologic comorbidities. This database was linked to the pediatric neurosurgical database. Clinical data were retrieved from medical files. RESULTS In total, 524 patients (50.2% males, mean age 8.5±3.5 years) were referred to brain MRI due to growth disturbances (n = 313), pubertal disorders (n = 183), prolactin hypersecretion (n = 18), central diabetes insipidus (n = 8), and obesity (n = 1). Incidental findings were found in 128 (24.4%) cases. Chiari type 1 malformation was more prevalent in patients with growth disturbances (P<.001). Small pituitary cysts were observed in 20 (3.8%) patients, and pineal cysts in 25 (4.8%) patients, mostly girls (68%, P<.001). White matter lesions were diagnosed in 30 (5.7%) patients, none with clinical evidence of neurologic disease. Brain asymmetry without clinical significance and developmental venous anomalies were observed in 14 (2.7%) and 8 (1.5%) patients, respectively. Twelve patients were diagnosed with intracranial tumors, and 5 required surgical intervention for a histopathologic diagnosis of juvenile pilocytic astrocytoma (n = 3), choroid plexus papilloma (n = 1), or inconclusive (n = 1). The rest were managed conservatively. CONCLUSION Incidental findings on brain MRIs of pediatric patients referred by endocrinologists are common and raise dilemmas. The spectrum ranges from structural disruptions to tumors. Decision-making is individualized and patient-centered.
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Affiliation(s)
- Avivit Brener
- From the Pediatric Endocrinology and Diabetes Unit, Tel-Aviv, Israel.
| | | | - Shelly I Shiran
- the Pediatric Radiology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Erez Azoulay
- From the Pediatric Endocrinology and Diabetes Unit, Tel-Aviv, Israel
| | - Li-Tal Pratt
- the Pediatric Radiology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ronit Precel
- the Pediatric Radiology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Liat Ben-Sira
- the Pediatric Radiology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ori Eyal
- From the Pediatric Endocrinology and Diabetes Unit, Tel-Aviv, Israel
| | | | - Jonathan Roth
- the Department of Pediatric Neurosurgery, Tel-Aviv, Israel
| | - Yael Lebenthal
- From the Pediatric Endocrinology and Diabetes Unit, Tel-Aviv, Israel
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Choque-Velasquez J, Colasanti R, Baluszek S, Resendiz-Nieves J, Muhammad S, Ludtka C, Hernesniemi J. Systematic review of pineal cysts surgery in pediatric patients. Childs Nerv Syst 2020; 36:2927-2938. [PMID: 32691194 PMCID: PMC7649165 DOI: 10.1007/s00381-020-04792-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments. METHODS The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles. RESULTS The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001). CONCLUSIONS Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland. .,Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy ,Department of Neurosurgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Szymon Baluszek
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, Warsaw, Poland ,Clinical Department of Neurosurgery, Central Clinical Hospital Ministry of Interior, Warsaw, Poland
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland
| | - Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland ,Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christopher Ludtka
- Department of Biomedical Engineering, University of Florida, Florida, USA
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland ,Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou, China
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Dangouloff-Ros V, Roux CJ, Boulouis G, Levy R, Nicolas N, Lozach C, Grevent D, Brunelle F, Boddaert N, Naggara O. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2019; 40:1818-1823. [PMID: 31624116 DOI: 10.3174/ajnr.a6281] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The detection of incidental findings on children's brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. PURPOSE Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: "incidental," "findings," "brain," "MR imaging." STUDY SELECTION Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. DATA ANALYSIS Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. DATA SYNTHESIS Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8-26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1-28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2-16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5-1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1-0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5-11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). LIMITATIONS Limitations were no age stratification or ethnicity data and variation in the design of included studies. CONCLUSIONS The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.
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Affiliation(s)
- V Dangouloff-Ros
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C-J Roux
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - G Boulouis
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Nicolas
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C Lozach
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - D Grevent
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - F Brunelle
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - O Naggara
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
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Storey M, Lilimpakis K, Grandal NS, Rajaraman C, Achawal S, Hussain M. Pineal cyst surveillance in adults - a review of 10 years' experience. Br J Neurosurg 2019; 34:565-568. [PMID: 31264489 DOI: 10.1080/02688697.2019.1635989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Pineal cysts are common benign incidental findings in adults. There are no commonly accepted criteria for follow up or indications for intervention. We looked at our outcomes for this condition to explore their natural history and review our surveillance criteria.Method: Retrospective review of multidisciplinary team meetings at a tertiary neurosurgical centre over 10 years. Data relating to demographics, presenting symptoms, maximum diameter, duration of surveillance, final diagnosis and overall outcome were extracted from electronic patient records and available MRI. Data were analysed using IBM SPSS version 24.Result: Seventy-seven pineal cysts were identified. Female to male ratio was 1.43, female mean age was 38.6 and male mean age was 50.4. An increase in referral frequency was observed over the study period (mean increase of 1.4 cases per year). Presenting symptoms of headache in 45% and visual and hearing symptoms in 38.5% were recorded and baseline mean maximum diameter was 13.4mm. 20 patients were discharged on presentation, 54 were booked for at least one follow-up scan with a median follow up period of 14 months. The mean change in maximum diameter was 0.04mm over 18 months. Three patients (3.9%) underwent endoscopic biopsy and CSF diversion for cysts all more than 20mm with radiological evidence of hydrocephalus. In 100% of cases, the initial MDT diagnosis and final diagnosis were concordant.Conclusions: No patient under surveillance required surgical treatment and those managed surgically were symptomatic with large cysts and hydrocephalus on presentation. A majority of pineal cysts remained unchanged during the MRI follow-up, therefore our review suggests that routine follow-up of pineal cysts is not necessary in the absence of unusual radiological characteristics or related clinical symptoms.
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Affiliation(s)
- Mathew Storey
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | | | | | | | | | - Masood Hussain
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
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12
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Gokce E, Beyhan M. Evaluation of pineal cysts with magnetic resonance imaging. World J Radiol 2018; 10:65-77. [PMID: 30079153 PMCID: PMC6068724 DOI: 10.4329/wjr.v10.i7.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate radiological imaging findings of patients who had been found to have pineal cyst (PC) in brain magnetic resonance imaging (MRI).
METHODS A total of 9546 patients who had brain MRI examination in March 2010-January 2018 period were studied. Fifty-six patients (44 female and 12 male) found to have PC were evaluated. Eighteen of the patients had had follow-up examinations of 2-94 mo (mean 30.50 ± 28.83). PC dimensions and volume, radiological imaging features (signal intensities, contours, internal septation-loculation and contrast-enhancement features) and natural history in cases who had been followed-up were evaluated by two radiologists.
RESULTS Of 9546 patients, 5555 were female (58.2%) and 3991 male (41.8%). Age range was 1-99 (mean 43.18 ± 20.94). PC frequency was calculated to be 0.58%. Forty-four of the 56 patients (78.57%) with PC were female and 12 male (21.43%), and their age range was 5-61 (mean 31.26 ± 12.73). Thirty-five of the PCs were typical (62.50%) and 21 (37.50%) were atypical. No significant difference was found between initial and final imaging sizes of PCs which were monitored by follow-up examinations (P > 0.05).
CONCLUSION PCs are cysts which do not show clear size and natural changes and are more frequently observed in females and in adult ages. Most of them are isointense with cerebrospinal fluid on T1 and T2A weighted images, hyperintense compared to cerebrospinal fluid on fluid-attenuated inversion recovery; sequence and smoothly contoured. Their typical forms have peripheral rim and multilocular ones may have septal contrast-enhancement.
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Affiliation(s)
- Erkan Gokce
- Department of Radiology, Gaziosmanpaşa University, School of Medicine, Tokat 60100, Turkey
| | - Murat Beyhan
- Department of Radiology, Tokat State Hospital, Tokat 60100, Turkey
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13
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Sleep disorders in children with incidental pineal cyst on MRI: a pilot study. Sleep Med 2018; 48:127-130. [PMID: 29906628 DOI: 10.1016/j.sleep.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/26/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION For several years, pineal cysts have been considered an incidental finding on brain MRI's even though research and case reports have shown a possible association of pineal cysts with headaches and sleep disturbances. This pilot study aims to evaluate sleep disorders in school-age children with an incidental pineal cyst in an otherwise normal brain MRI. METHOD Children aged 6-12 years, who were referred for evaluation of headaches, tics, or syncope, and had an incidental pineal cyst on an otherwise normal brain MRI were included and compared to a control group of children with the same referral reasons but with a normal MRI and to a cohort of normal controls. The Sleep Disturbance Scale for Children (SDSC) was administered to the parents. Exclusion criteria included use of medications that affect sleep, seizures, brain abnormalities, tumors, or comorbid medical conditions that affect sleep. RESULTS Eighteen children (11 females) with pineal cysts, 19 children with normal MRI, and 100 age- and sex-matched controls were included in our study. There were statistically significant differences in the total SDSC score (with a difference of 10 between the median scores) and in two of the six domains of this scale. Children with pineal cysts scored significantly higher in the domains of disorders of excessive sleepiness and disorders of initiating and maintaining sleep than the two control groups. The scores in these two domains correlated significantly with the size of the cyst. CONCLUSION School-age children with pineal cysts have significantly increased levels of sleepiness and difficulty with sleep initiation and maintenance.
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