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Genetic and Rare Diseases Information Center (GARD)

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Pineal cyst

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* Not a rare disease

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Your Question

My wife was diagnosed with a cyst on her pineal gland. We have been researching information and have seen both good and bad things. She's had two MRIs and bloodwork done, and the doctors believe it's benign. What else can we do?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What are pineal cysts?

Pineal cysts are cysts of the pineal gland, a small organ in the brain shaped like the seed of a pine cone that is responsible for making melatonin, a hormone that regulates sleep.  Pineal cysts may be found by chance in up to 10% of people undergoing CT or MRI brain imaging, and they occur in three times more women than men.  Most pineal cysts do not cause symptoms and stay the same size over time (remain stable).[1]  In the rare circumstance where a pineal cyst does cause symptoms, it may cause headaches, hydrocephalus, eye movement abnormalities, and Parinaud syndrome.[2]  Because most pineal cysts do not grow or cause symptoms, there are no established guidelines for routine follow-up for individuals with pineal cysts.  Treatment is usually only considered when a cyst is causing symptoms.[3]  In the past, treatment for symptomatic pineal cysts included surgery to remove the cyst (craniotomy); more recently, less invasive procedures such as stereotactic aspiration or endoscopic treatment have been recommended.[4]
Last updated: 10/16/2012

How might a pineal cyst be managed if it does not cause symptoms?

There is limited information about what happens to a pineal cyst over time.  Several studies have shown that most pineal cysts remain stable and do not increase in size or cause symptoms later in life.[5][6]  One study found that larger cysts were more likely to decrease in size over time[5], and there is currently no evidence that larger cysts are more likely to cause symptoms.[6]  

Because guidelines for management depend on an understanding of the typical course of a condition, and currently there is limited information about pineal cysts, there is some debate about the most appropriate way to manage these cysts.[3]  Some studies do not recommend repeated magnetic resonance imaging (MRI) of the cyst.[3]  Other studies state that repeated imaging of a pineal cyst is not required.[5]  Another approach is for individuals with a pineal cyst to have regular check-ups with their personal doctor; if at any point new symptoms arise that may be related to the pineal cyst, repeat imaging should be done.[3][6]
Last updated: 8/18/2014

What are the signs and symptoms of pineal cysts?

Pineal cysts are usually asymptomatic. However, there are rare cases of pineal cysts which cause headaches, hydrocephalus, disturbances in vision (gaze palsy), Parinaud syndrome, and vertigo.[7]  In rare cases, individuals with symptomatic pineal cysts may have other symptoms such as difficulty moving (ataxia), mental and emotional disturbances, seizures, sleep (circadian rhythm) troubles, hormonal imbalances that may cause precocious puberty, or secondary parkinsonism.[8]
Last updated: 12/29/2011

How might symptomatic pineal cysts be treated?

Whether patients with symptomatic pineal cysts should be monitored and/or treated is still unclear.  However, surgery is usually recommended for those individuals with pineal cysts that cause hydrocephalus, worsening neurological symptoms such as headache or disturbance of vision, or enlargement of the cyst over time.[9][2]  Treatment may include surgery to remove the cyst, sometimes followed by the placement of a ventriculoperitoneal shunt.  Aspiration of the contents of the cyst using ultrasound guidance has been explored as an alternative approach to surgery, and more recently, endoscopic procedures have been used.[4]
Last updated: 12/29/2011

References
  • Fakhran S, Escott EJ. Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging?. American Journal of Neuroradiology. 2008; 29:159-163. http://www.ncbi.nlm.nih.gov/pubmed/17925371. Accessed 12/13/2011.
  • Al-Holou WN, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. 2010;
  • Gaillard F, Jones J. Masses of the pineal region: clinical presentation and radiographic features. Postgraduate Medical Journal. 2010; 86:597-607. http://www.ncbi.nlm.nih.gov/pubmed/20971711. Accessed 12/13/2011.
  • Costa F, Fornari M, Valla P, Servello D. Symptomatic Pineal Cyst: Case Report and Review of the Literature. Minim. Invas. Neurosurg.. 2008; 51:231-233.
  • Al-Holou WN, Terman SW, Kilburg C, Garton HJ, Muraszko KM, Chandler WF, Ibrahim M, Maher CO.. Prevalence and natural history of pineal cysts in adults. Journal of Neurosurgery. December, 2011; 115(6):1106-1114. http://www.ncbi.nlm.nih.gov/pubmed/21780858. Accessed 12/31/2013.
  • Barboriak DP, Lee L, Provenzale JM. Serial MR imaging of pineal cysts: implications for natural history and follow-up. Am J Roentgenol. 2001; 176:737-743. http://www.ncbi.nlm.nih.gov/pubmed/11222216. Accessed 12/31/2013.
  • Wajd NA, Maher CO, Muraszko KM, Garton HJL. The natural history of pineal cysts in children and young adults. J. Neurosurg. Pediatrics. 2010;
  • Bosnjak J, Budisic M, Azman D, Strineka M, Crnjakovic M, Demarin V. Pineal gland cysts--an overview. Acta Clin Croat. 2009;
  • Taraszewska A, Matyja E, Koszewki W, Zaczynski A, Bardadin K, Czernicki Z. Asymptomatic and symptomatic glial cysts of the pineal gland. Folia Neuropathol. 2008;
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.