The pineal gland is a small gland lying in the center of the brain between the two cerebral hemispheres. While the cerebrum controls the major functions of the body like speech, memory, thinking and movement, the pineal gland is responsible for the synthesis of a hormone called as melatonin, which plays a crucial rule in the regulation of the sleep cycle of the body.
Any condition affecting the pineal gland becomes important because of the strategic position of the pineal gland. Enlargement of the gland may impinge upon the two cerebri and affect their function. Compression of the dorsal portions of the mid-brain may lead to an increase in the intracranial pressure, a condition called as hydrocephalus in medical parlance. Apart from that, the patient may also complain of focal neurological deficit. Any abnormal growth in the pineal gland may range from completely benign, like the pineal cysts, to malignant tumors, like pineoblastoma. On rare occasions, vascular malformations may also give rise to tumor like growth.
Pineal cysts are usually found accidentally in 10% of the people who undergo a brain CT scan or MRI for some other reasons like head trauma, migraine and bouts of dizziness. They are three times more common in women. They are rare before puberty and after menopause, a feature that suggests that hormones may be playing a role in causing these cysts. Pineal cysts remain largely asymptomatic and stay the same size over long duration of time. Most of these cysts are less than 0.5 cm in size. However, on rare occasion, a pineal cyst may be large enough to produce symptoms.
The most common symptom associated with a pineal cyst is headache. The headache is often severe in nature and is usually accompanied with a rise in the intracranial pressure leading to papilledema, nausea and projectile vomiting. Patients with a symptomatic pineal cyst may complain of abnormal eye movements and Parinaud syndrome. The latter is a condition in which the patient is unable to look up. Very large pineal cysts may even lead to seizures and bouts of unconsciousness.
Before undergoing any surgery for pineal cyst, it is important to ascertain that it is the main reasons behind your headache. This is because in most of the cases, pineal cysts do not produce any symptoms. The headache may be because of stress, too much of coffee, improper diet or inadequate sleep. You may need to undergo follow- up imaging of the cyst. However, if your neurosurgeon feels that your symptoms can be attributed to the pineal cyst, surgery is the treatment of choice.
Most of the neurosurgeons perform a craniotomy to remove a pineal cyst. However, with advancing technology, craniotomy is gradually being replaced by less invasive forms of surgery like stereotactic aspiration of the cyst or endoscopic treatment of the cyst. During the endoscopic treatment, third ventriculostomy is performed followed by fenestration of the pineal cyst. The technique is performed with the help computerized neuro-navigation so as to cause minimal damage to the surrounding structures. This form of surgery is usually considered as safe and the increase in the intracranial pressure, which gives rise to the headache, is resolved within 24 hours.
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