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Kałużna M, Katulska K, Ziemnicka K, Kompf P, Budny B, Komarnicki P, Rabijewski M, Moczko J, Kałużny J, Ruchała M. Magnetic resonance imaging does not distinguish Kallmann syndrome from normosmic isolated hypogonadotropic hypogonadism. Endocr Connect 2025; 14:e240437. [PMID: 39719010 PMCID: PMC11770403 DOI: 10.1530/ec-24-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 12/26/2024]
Abstract
Introduction and objectives Isolated hypogonadotropic hypogonadism (IHH) may be associated with pituitary gland and olfactory system disorders. We aimed to correlate findings of magnetic resonance imaging (MRI) of the pituitary gland and olfactory system in IHH patients with the patients' olfactory phenotype. Patients and methods The present research was a single-center retrospective case-control study. MRI patterns of the pituitary gland and olfactory system were studied in 46 patients, of whom 29 (63%) were classified on the basis of olfactometry as having Kallmann syndrome (KS) (16 patients with anosmia and 13 patients with hyposmia) and 17 (37%) as having normosmic IHH (nIHH). Results were compared with age- and sex-matched healthy controls. Genetic diagnosis was conducted in all IHH patients based on next-generation sequencing. Results Almost 70% prevalence of pituitary hypoplasia was observed in IHH subjects. Olfactory bulb (OB) abnormalities were identified in 80.4% of all patients, both the KS (82.8%) and the nIHH (76.5%) subjects. Incidence of unilaterally abnormal, hypoplastic olfactory sulcus (OS) was equally frequent in nIHH and KS. Statistically, piriform cortical thickness was significantly lower in all patient groups than in controls. Conclusions MRI cannot exclusively differentiate between KS and nIHH, as both conditions may present with OB and OS abnormalities. A surprisingly high frequency of olfactory system abnormalities was observed in nIHH patients, while anterior pituitary hypoplasia was prevalent across all IHH patients. Notably, OB abnormalities were more predominant in KS patients than in those with nIHH.
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Affiliation(s)
- Małgorzata Kałużna
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, University Clinical Hospital, Poznan, Poland
| | - Katarzyna Katulska
- Department of General Radiology and Neuroradiology, General Radiology Unit, Poznań University of Medical Sciences, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, University Clinical Hospital, Poznan, Poland
| | - Pola Kompf
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, University Clinical Hospital, Poznan, Poland
| | - Paweł Komarnicki
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, University Clinical Hospital, Poznan, Poland
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poland
| | - Jarosław Kałużny
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, University Clinical Hospital, Poznan, Poland
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Liu APY, Li BK, Vasiljevic A, Dewan MC, Tamrazi B, Ertl-Wagner B, Hansford JR, Pfaff E, Mynarek M, Ng HK, Tsang DS, Gottardo NG, Gajjar A, Bouffet E, Dufour C, Pizer B, Schiff D, Jenkinson MD, Lombardi G, Wen PY, van den Bent MJ, Huang A. SNO-EANO-EURACAN consensus on management of pineal parenchymal tumors. Neuro Oncol 2024; 26:2159-2173. [PMID: 39073785 PMCID: PMC11630543 DOI: 10.1093/neuonc/noae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Pineal parenchymal tumors are rare neoplasms for which evidence-based treatment recommendations are lacking. These tumors vary in biology, clinical characteristics, and prognosis, requiring treatment that ranges from surgical resection alone to intensive multimodal antineoplastic therapy. Recently, international collaborative studies have shed light on the genomic landscape of these tumors, leading to refinement in molecular-based disease classification in the 5th edition of the World Health Organization (WHO) classification of tumors of the central nervous system. In this review, we summarize the literature on diagnostic and therapeutic approaches, and suggest pragmatic recommendations for the clinical management of patients presenting with intrinsic pineal region masses including parenchymal tumors (pineocytoma, pineal parenchymal tumor of intermediate differentiation, and pineoblastoma), pineal cyst, and papillary tumors of the pineal region.
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Affiliation(s)
- Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan K Li
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexandre Vasiljevic
- Service D’Anatomie Et Cytologie Pathologiques, CHU de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - Michael C Dewan
- Division of Pediatric Neurological Surgery, Vanderbilt University Medical Center, Tennessee, USA
| | - Benita Tamrazi
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Birgit Ertl-Wagner
- Division of Neuroradiology, Department of Diagnostic & Interventional Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jordan R Hansford
- Michael Rice Centre for Hematology and Oncology, Women’s and Children’s Hospital; South Australia Health and Medical Research Institute; South Australia Immunogenomics Cancer Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Elke Pfaff
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
- Pediatric Glioma Research Group (B360), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Pediatric Glioma Research, Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Martin Mynarek
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nicholas G Gottardo
- Department of Pediatric & Adolescent Oncology and Haematology, Perth Children’s Hospital and Brain Tumor Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, France
- INSERM, Molecular Predictors and New Targets in Oncology, Paris-Saclay University, Villejuif, France
| | - Barry Pizer
- School of Life Sciences, University of Liverpool, Liverpool, UK
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Giuseppe Lombardi
- Department of Medical Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martin J van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr molewaterplein 40, Rotterdam, The Netherlands
| | - Annie Huang
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ludwig HC, Dreha-Kulaczewski S, Bock HC. Paediatric pineal region cysts: enigma or impaired neurofluid system? Childs Nerv Syst 2023; 39:3457-3466. [PMID: 37261536 PMCID: PMC10684616 DOI: 10.1007/s00381-023-06000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Pineal region cysts (PCs) may affect the tectum and aqueduct and cause deep central vein congestion. Beside headaches, PC often causes a broad range of symptoms, leading to prolonged diagnosis and therapy. The aims of this study are to reveal parameters that might explain the ambiguity of the symptoms and to identify factors in association with the respiration-driven neurofluid system. METHODS This retrospective study included 28 paediatric patients (mean age 11.6 years) who received surgical treatment and 18 patients (mean age 11.3 years) who were followed conservatively. Symptoms, time to diagnosis, cyst size, ventricular indices, head circumference and postoperative outcome, were analysed. Four patients were investigated for CSF dynamics with real-time MRI. The mean follow-up time was 1.6 years. RESULTS The most common early onset symptoms were headaches (92%), blurred vision (42.8%), sleep disturbances (39.3%) and vertigo (32.1%). Tectum contact was observed in 82% of patients, and MRI examinations revealed that imaging flow void signals were absent in 32.1% of patients. The maximal cyst diameters were 13.7 × 15.6 mm (mean). Together with a postoperative flow void signal, 4 patients recovered their respiration-driven CSF aqueductal upward flow, which was not detectable preoperatively. After surgery the main symptoms improved. CONCLUSION Despite proximity to the aqueduct with frequently absent flow void signals, hydrocephalus was never detected. Data from real-time MRI depicted a reduced preoperative filling of the ventricular CSF compartments, indicating a diminished fluid preload, which recovered postoperatively.
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Affiliation(s)
- Hans C Ludwig
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Steffi Dreha-Kulaczewski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Hans Christoph Bock
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Szathmari A, Vasiljevic A, Di Rocco F, Beuriat PA, Mottolese C. Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon. Childs Nerv Syst 2023; 39:3467-3474. [PMID: 37898987 DOI: 10.1007/s00381-023-06181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. METHODS This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. RESULTS Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. CONCLUSIONS Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.
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Affiliation(s)
- Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, 69500, Bron, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France.
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Tang SJ, Yeung JT. Editorial: Prevalence of pineal cysts in healthy individuals: Emphasis on size, morphology and pineal recess crowding. J Neurol Sci 2023; 453:120820. [PMID: 37804791 DOI: 10.1016/j.jns.2023.120820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Si Jie Tang
- School of Medicine, 21772 University of California Davis Medical Center, Sacramento, CA, USA
| | - Jacky T Yeung
- Department of Neurosurgery, Yale University School of Medicine PO Box 208082, New Haven, CT 06520, USA.
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McDowell MM, Kim S, Greene S. Clinical and Radiographic Features of Pineal Cysts in Pediatric and Young Adult Patients. World Neurosurg 2023; 176:e719-e727. [PMID: 37315894 DOI: 10.1016/j.wneu.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Michael M McDowell
- Division of Neurological Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Song Kim
- Division of Neurological Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephanie Greene
- Division of Neurological Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Firn ET, Garcia HH, Rapalino O, Cervantes-Arslanian AM. Imaging of congenital and developmental cystic lesions of the brain: a narrative review. Expert Rev Neurother 2023; 23:1311-1324. [PMID: 37877290 DOI: 10.1080/14737175.2023.2267175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Congenital and developmental intracranial cysts represent a large heterogenous group with varied presentations and etiologies. They can range from normal variants to pathologic lesions often associated with known congenital syndromes or acquired insults. While some are incidentally found, others are symptomatic or may become symptomatic over time. The preferred type of neuroimaging for timely diagnosis helps determine appropriate management and treatment, if indicated. AREAS COVERED In this narrative review article, authors present a comprehensive description of developmental cystic lesions. Imaging descriptions are provided for each type of cystic lesion as well as several representative images. EXPERT OPINION As advanced neuroimaging techniques become more ubiquitous in clinical use, more light may be shed on the natural history of certain intracranial cystic lesions throughout the lifespan. This includes prenatal imaging for early identification and prognostication to surveillance imaging into advanced age to ascertain associations of certain cystic lesions with age-related cognitive dysfunction.
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Affiliation(s)
- Eliza T Firn
- Child Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Neurosurgery & Medicine, Boston, MA, USA
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Otto Rapalino
- Neuroradiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurology, Neurosurgery & Medicine, Boston, MA, USA
- Neurology, Neurosurgery, and Medicine, Boston University School of Medicine, Massachusetts, USA
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Eide PK, Lindstrøm EK, Pripp AH, Valnes LM, Ringstad G. Physiological alterations of pineal recess crowding in symptomatic non-hydrocephalic pineal cysts. Brain Commun 2023; 5:fcad078. [PMID: 37501910 PMCID: PMC10371044 DOI: 10.1093/braincomms/fcad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 07/29/2023] Open
Abstract
Pineal cysts are prevalent in the population. Due to more widespread use of magnetic resonance imaging, an increasing number of symptomatic patients with non-hydrocephalic pineal cysts are referred to neurologists and neurosurgeons. Currently, there is no generally accepted theoretical framework for linking symptoms to a pineal cyst. We have previously suggested that cyst-induced crowding of the pineal recess may affect venous runoff from the deep cerebral veins crossing the cyst. However, evidence underpinning this hypothesis is sparse. In the present study, we asked whether crowding of the pineal recess without imaging signs of hydrocephalus may be accompanied with alterations in blood flow of the internal cerebral veins, cerebrospinal fluid flow in the Sylvian aqueduct and cerebrospinal fluid-mediated tracer clearance from the brain along extravascular pathways (referred to as glymphatic function). This prospective, observational study included symptomatic individuals with non-hydrocephalic pineal cysts who underwent a standardized magnetic resonance imaging protocol (n = 25): Eleven patients were treated surgically with craniotomy and cyst extirpation and 14 individuals were managed conservatively without surgery. Our findings suggest that cyst-induced crowding of the pineal recess may have brain-wide effects: (i) There was a significant negative correlation between degree of crowding within the pineal recess and change in maximum venous flow velocity at the cyst, and a significant positive correlation between maximum venous flow velocity change at the cyst and net cerebrospinal fluid flow in the Sylvian aqueduct; (ii) increased degree of crowding in the pineal recess was accompanied by significantly impaired glymphatic enrichment in the cerebral cortex and subcortical white matter, indicative of a brain-wide effect in this cohort who also reported markedly impaired subjective sleep quality; (iii) there was a significant negative correlation between the apparent diffusion coefficient (suggestive of interstitial water content) within the thalamus and glymphatic enrichment of tracer and (iv) pineal recess crowding associated with symptoms. Comparison of the surgical cases [in whom 10/11 (91%) reported marked clinical improvement at follow-up] and the conservatively managed cases [in whom 1/14 (7%) reported marked clinical improvement at follow-up] showed differences in pre-treatment glymphatic tracer enrichment as well as differences in tracer enrichment in subarachnoid cerebrospinal fluid spaces. Taken together, we interpret these observations to support the hypothesis that cyst-induced crowding of the pineal recess without hydrocephalus may alter blood flow of the internal cerebral veins and cerebrospinal fluid flow and even cause brain-wide impairment of glymphatic transport with possible implications for cerebrospinal fluid transport of trophic factors such as melatonin.
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Affiliation(s)
- Per Kristian Eide
- Correspondence to: Per Kristian Eide, MD, PhD Department of Neurosurgery Oslo University Hospital—Rikshospitalet Pb 4950 Nydalen, Sognvannsveien 20 N-0424 Oslo, Norway E-mail:
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, N-0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, N-0176 Oslo, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital—Rikshospitalet, N-0424 Oslo, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital- Rikshospitalet, N-0424 Oslo, Norway
- Department of Geriatrics and Internal Medicine, Sorlandet Hospital, N-4838 Arendal, Norway
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Abstract
The pineal gland is a interface between light-dark cycle and shows neuro-endocrine functions. Melatonin is the primary hormone of pineal gland, secreted at night. The night-time melatonin peak regulates the physiological functions at dark. Melatonin has several unique features as it synchronises internal rhythm with daily and seasonal variations, regulates circadian rhythm and sleep-wake cycle. Physiologically melatonin involves in detoxification of free radicals, immune functions, neuro-protection, oncostatic effects, cardiovascular functions, reproduction, and foetal development. The precise functions of melatonin are exhibited by specific receptors. In relation to pathophysiology, impaired melatonin secretion promotes sleep disorder, cancer progression, type-2 diabetes, and neurodegenerative diseases. Several reports have highlighted the therapeutic benefits of melatonin specially related to cancer protection, sleep disorder, psychiatric disorders, and jet lag problems. This review will touch the most of the area of melatonin-oriented health impacts and its therapeutic aspects.
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Takahashi T, Wood SJ, Yung AR, Nelson B, Lin A, Yuen HP, Phillips LJ, Suzuki M, McGorry PD, Velakoulis D, Pantelis C. Pineal morphology of the clinical high-risk state for psychosis and different psychotic disorders. Schizophr Res 2022; 244:1-7. [PMID: 35487129 DOI: 10.1016/j.schres.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pineal volume reductions have been reported in schizophrenia and clinical high-risk states for the development of psychosis, supporting the role of melatonin dysregulation in the pathophysiology of psychosis. However, it remains unclear whether pineal volume is associated with the later onset of psychosis in individuals at clinical high-risk (CHR) of psychosis or if pineal atrophy is specific to schizophrenia among different psychotic disorders. METHODS This magnetic resonance imaging study examined the volume of and cyst prevalence in the pineal gland in 135 individuals at CHR of psychosis [52 (38.5%) subsequently developed psychosis], 162 with first-episode psychosis (FEP), 89 with chronic schizophrenia, and 87 healthy controls. The potential contribution of the pineal morphology to clinical characteristics was also examined in the CHR and FEP groups. RESULTS Pineal volumes did not differ significantly between the CHR, FEP, and chronic schizophrenia groups, but were significantly smaller than that in healthy controls. However, pineal volumes were not associated with the later onset of psychosis in the CHR group or FEP sub-diagnosis (i.e., schizophrenia, schizophreniform disorder, affective psychosis, and other psychoses). No significant differences were observed in the prevalence of pineal cysts between the groups, and it also did not correlate with clinical characteristics in the CHR and FEP groups. CONCLUSION These results suggest that pineal atrophy is a general vulnerability marker of psychosis, while pineal cysts do not appear to contribute to the pathophysiology of psychosis.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Research Center for Idling Brain Science, University of Toyama, Toyama, Japan.
| | - Stephen J Wood
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | - Alison R Yung
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Barnaby Nelson
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Patrick D McGorry
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia; Neuropsychiatry, Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; North Western Mental Health, Western Hospital Sunshine, St. Albans, Victoria, Australia
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Kühn S, Sönksen SE, Noble HJ, Knopf H, Frischmuth J, Waldeck S, Müller-Forell W, Weber F, Bressem L. Incidental Findings in Head and Brain MRI of Military Pilots and Applicants: Consequences for Medical Flight Fitness. Aerosp Med Hum Perform 2022; 93:450-457. [PMID: 35551731 DOI: 10.3357/amhp.5976.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: With improved imaging technology, the number of incidental findings detected in cerebral MRI is increasing. This is a challenge that the German Air Force has to deal with in the context of standardized MRI examinations of young pilot candidates and pilots.METHODS: The German Air Force Centre of Aerospace Medicine hosted a 2-d conference to develop recommendations and procedures for the handling of some of the most frequently encountered cerebral incidental findings.RESULTS: Radiological MRI findings from a total of 2724 routine examinations of the skull of pilots and pilot applicants (26.8 ± 10.6 yr old; range from 16 to 62; over 80% range from 17 to 33; 96% men) revealed that in 28.1% of the examinations, one or more incidental findings were discovered. For seven of the following categories of incidental findings, decision guidelines could be established: white matter hyperintensities (N = 393; prevalence 14.4%; 95% CI 13.11-15.75), pinealis cysts (317; 11.6%; 10.43-12.84), developmental venous anomalies (64; 2.3%; 1.78-2.92), cavernomas (15; 0.6%; 0.27-0.83), aneurysms (14; 0.5%; 0.25-0.78), cholesterol granulomas (22; 0.8%; 0.47-1.14), and heterotopias of the gray matter (6; 0.2%; 0.04-0.4).CONCLUSION: Considering pilots health and aviation safety, a waiver decision is often possible after thorough discussion, depending on the specific criteria of the incidental finding and of the type of license.Kühn S, Sönksen S-E, Noble H-J, Knopf H, Frischmuth J, Waldeck S, Müller-Forell W, Weber F, Bressem L. Incidental findings in head and brain MRI of military pilots and applicants: consequences for medical flight fitness. Aerosp Med Hum Perform. 2022; 93(5):450-457.
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12
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Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach-surgical strategies, complications, and their avoidance. Neurosurg Rev 2022; 45:3327-3337. [PMID: 35829978 PMCID: PMC9492705 DOI: 10.1007/s10143-022-01831-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/03/2023]
Abstract
Indications for surgery of pineal cysts without ventriculomegaly are still under debate. In view of the limited data for pineal cyst resection in the absence of hydrocephalus, and the potential risk of this approach, we have analyzed our patient cohort focusing on strategies to avoid complications according to our experience in a series of 73 pineal cyst patients. From 2003 to 2015, we reviewed our database retrospectively for all patients operated on a pineal cyst. Furthermore, we prospectively collected patients from 2016 to 2020. In summary, 73 patients with a pineal cyst were treated surgically between 2003 and 2020. All patients were operated on via a microscopic supracerebellar-infratentorial (SCIT) approach. The mean follow-up period was 26.6 months (range: 6-139 months). Seventy-three patients underwent surgery for a pineal cyst. An absence of enlarged ventricles was documented in 62 patients (51 female, 11 male, mean age 28.1 (range 4-59) years). Main presenting symptoms included headache, visual disturbances, dizziness/vertigo, nausea/emesis, and sleep disturbances. Complete cyst resection was achieved in 59/62 patients. Fifty-five of 62 (89%) patients improved after surgery with good or even excellent results according to the Chicago Chiari Outcome Scale, with complete or partial resolution of the leading symptoms. Pineal cysts resection might be an indication in certain patients for surgery even in the absence of ventriculomegaly. The high percentage of postoperative resolution of quality-of-life impairing symptoms in our series seems to justify surgery. Preoperatively, other causes of the leading symptoms have to be excluded.
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13
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Leon-Llamas JL, Villafaina S, Murillo-Garcia A, Rohlfs Domínguez P, Gusi N. Relationship between pineal gland, sleep and melatonin in fibromyalgia women: a magnetic resonance imaging study. Acta Neuropsychiatr 2021; 34:1-9. [PMID: 34903309 DOI: 10.1017/neu.2021.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A total of 80% of fibromyalgia (FM) population have reported poor sleep. In this regard, the pineal gland, involved in circadian rhythm processes as a key neuroendocrine organ which mainly synthesises and secretes melatonin, has never been studied before in this population. Therefore, this study aimed to evaluate the parenchyma pineal volume and its relation to sleep hours, sleep quality index and melatonin level at night. A total of 50 participants, 30 women with FM and 20 healthy control women underwent cranial magnetic resonance imaging. The total pineal volume, cyst pineal volume and parenchyma pineal volume were manually calculated in cubic millimetres. Also, the total pineal volume was estimated using Hasehawa method. Parenchyma pineal volume was significantly correlated with sleep hours (p-value = 0.041) and nocturnal melatonin level (p-value = 0.027). Moreover, there was also a non-significant correlation between parenchyma pineal volume and sleep quality index (p-value = 0.055). Furthermore, a mean parenchyma pineal volume of 102.00 (41.46) mm³ was observed, with a prevalence of 29.60% cyst in FM group. This is the first study that has reported pineal gland volumes, cyst prevalence and correlative relationships between parenchyma pineal volume and sleep hours and melatonin levels in women with FM.
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Affiliation(s)
- Juan Luis Leon-Llamas
- AFYCAV Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
| | - Santos Villafaina
- AFYCAV Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
- Teacher Training Collegue, University of Extremadura, Cáceres, Spain
| | - Alvaro Murillo-Garcia
- AFYCAV Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
| | - Paloma Rohlfs Domínguez
- AFYCAV Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
- Department of Psychology and Anthropology, School of Nursing and Occupational Therapy, University of Extremadura, Badajoz, Spain
- Department of Evolutionary Psychology and Education, Faculty of Education, University of Basque Country, Leioa, Spain
| | - Narcis Gusi
- AFYCAV Research Group, Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Health Institute Carlos III, Madrid, Spain
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14
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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: 6] [Impact Index Per Article: 1.5] [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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15
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Naegel S, Zeller J, Hougard A, Weise CM, Zuelow S, Kleinschnitz C, Obermann M, Solbach K, Holle D. No structural brain alterations in new daily persistent headache - a cross sectional VBM/SBM study. Cephalalgia 2021; 42:335-344. [PMID: 34601946 DOI: 10.1177/03331024211045653] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification. METHOD Magnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches. RESULTS No grey matter changes were detected using this sophisticated and cross-checked method. CONCLUSION The absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.,Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julia Zeller
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Paediatric Haematology and Oncology, Paediatrics III, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Anders Hougard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Stefan Zuelow
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Mark Obermann
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Neurology, Klinikum Weser-Egge, Höxter, Germany
| | - Kasja Solbach
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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16
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Montaser AS, Cho EY, Catalino MP, Hanna J, Smith TR, Laws ER. A Surgical Perspective on the Association between Cystic Lesions of the Pineal Gland (Descartes' Seat of the Soul) and the Pituitary (the Master Gland). J Neurol Surg B Skull Base 2021; 83:e598-e602. [DOI: 10.1055/s-0041-1735635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Rene Descartes (1596–1650), the famous philosopher and scientist, identified the pineal gland as the only cerebral structure not represented bilaterally, the “seat of the soul”; and the source of rational thought. Pineal cysts (PCs) are often incidentally identified in MRI studies, with a reported prevalence of 1 to 4.3%. Rathke cleft cysts (RCCs) are pituitary lesions accounting for <1% of intracranial masses. There are scant data in the literature addressing any association between these two midline cystic lesions.
Methods We reviewed the medical records of patients presenting at our institution from April 2008 through February 2020, whose records indicated a diagnosis of RCC, and those whose records included pineal lesions. Our objective was to evaluate the association between these two midline lesions. Brain MRI studies were reviewed for the presence of PCs; only patients with PCs that measured ≥5 mm in diameter were included.
Results We identified 116 patients with RCCs, and 34 patients with PCs, treated from April 2008 through February 2020. Among the RCC group, 14/116 patients (12%) had PCs. Among the PC group, 3/34 patients (8.8%) had RCCs. Overall, 17 patients (11.3%) had concomitant RCCs and PCs. The mean maximal diameter of the PCs was 7.5 mm (range = 5–17 mm), whereas the mean maximal diameter of RCCs was 13 mm (range = 5–40 mm).
Conclusion The incidental diagnosis of cystic lesions of the pineal and pituitary gland is increasingly reported, primarily because of advances in current diagnostic modalities. Our data demonstrated no clear consensual association between pineal and pituitary cysts.
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Affiliation(s)
- Alaa S. Montaser
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Elise Y. Cho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Michael P. Catalino
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jack Hanna
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Edward R. Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Potential contribution of pineal atrophy and pineal cysts toward vulnerability and clinical characteristics of psychosis. NEUROIMAGE-CLINICAL 2021; 32:102805. [PMID: 34461434 PMCID: PMC8405969 DOI: 10.1016/j.nicl.2021.102805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) studies reported pineal gland atrophy in schizophrenia patients and individuals at a clinical high risk of developing psychosis, implicating abnormalities in melatonin secretion in the pathophysiology of psychosis. However, it currently remains unclear whether the morphology of the pineal gland contributes to symptomatology and sociocognitive functions. METHODS This MRI study examined pineal gland volumes and the prevalence of pineal cysts as well as their relationship with clinical characteristics in 57 at risk mental state (ARMS) subjects, 63 patients with schizophrenia, and 61 healthy controls. The Social and Occupational Functioning Assessment Scale (SOFAS), the Schizophrenia Cognition Rating Scale (SCoRS), and the Brief Assessment of Cognition in Schizophrenia (BACS) were used to assess sociocognitive functions, while the Positive and Negative Syndrome Scale was employed to evaluate clinical symptoms in ARMS subjects and schizophrenia patients. RESULTS Pineal gland volumes were significantly smaller in the ARMS and schizophrenia groups than in the controls, while no significant differences were observed in the prevalence of pineal cysts. Although BACS, SCoRS, and SOFAS scores were not associated with pineal morphology, patients with pineal cysts in the schizophrenia group exhibited severe positive psychotic symptoms with rather mild negative symptoms. CONCLUSION The present results indicate the potential of pineal atrophy as a vulnerability marker in various stages of psychosis and suggest that pineal cysts influence the clinical subtype of schizophrenia.
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18
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Ndukuba K, Ogiwara T, Nakamura T, Kamiya K, Hanaoka Y, Horiuchi T, Ohaegbulam S, Hongo K. Surgical strategy for symptomatic pineal cyst: is endoscopit third ventriculostomy necessary in addition to cyst fenestration? NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:627-633. [PMID: 34552294 PMCID: PMC8437992 DOI: 10.18999/nagjms.83.3.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Symptomatic large pineal cyst (PC) remains a rare entity. The stable natural course of asymptomatic PCs is well established. However, large cysts may cause pressure-related symptoms necessitating surgical intervention. The surgical strategy for symptomatic PCs is still controversial. Regardless of the approach, total resection of the cyst is not mandatory. The endoscopic approach allows cyst fenestration in patients with associated obstructive hydrocephalus. On the other hand, the necessity of simultaneous endoscopic third ventriculostomy (ETV) is still debatable. Here, we report a case of a woman who underwent endoscopic cyst fenestration, biopsy, and third ventriculostomy for a large symptomatic PC and discuss the surgical strategy. A 30-year-old woman presented with headache and diplopia, MRI showed a large PC and accompanying obstructive hydrocephalus. Simultaneous cyst fenestration, biopsy and ETV with endoscopy was successfully completed. She had an uneventful recovery period with immediate relief of symptoms. Although, the aqueduct was communicated due to cyst shrinkage, the patency of the third ventricular stoma was demonstrated in long-term follow-up scans. Based on clinical course of the present case, we concluded that ETV in addition to cyst fenestration should be considered necessary and beneficial in cases of large symptomatic PC with associated hydrocephalus whenever an endoscopic intraventricular approach is considered.
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Affiliation(s)
- Kelechi Ndukuba
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
,Unit of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keisuke Kamiya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Samuel Ohaegbulam
- Unit of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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19
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Singh SK, Sharma KK, Kumar T. Pleomorphic xanthoastrocytoma at the pineal region: rare case report with successful surgical management. EGYPTIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1186/s41984-021-00107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pineal region tumors are commonly present in the pediatric age group. However, pleomorphic xanthoastrocytoma (PXA) is very rare at this region, and only few case reports have been reported till now in literature.
Case presentation
Here, we report a rare case of pineal region, juxta-thalamic, pleomorphic xanthoastrocytoma (PXA) in an 11-year-old male child. The child presented with severe headache after which MRI was done. It was suggestive of pineal region low-grade tumor. The patient was operated in Parkbench position with SCIT (supracerebellar approach) in a retractor-free manner. Gross total resection was done. However, the patient developed postoperative left-sided hemiparesis. It got improved in 1 month, and the patient became ambulatory. Histopathology came out as pleomorphic xanthoastrocytoma.
Conclusion
Surgical management should include careful resection near the internal capsule to avoid postoperative hemiparesis. Also, shunt should be delayed in the cystic cavity created by resection of tumor.
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20
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Jenkinson MD, Mills S, Mallucci CL, Santarius T. Management of pineal and colloid cysts. Pract Neurol 2021; 21:practneurol-2020-002838. [PMID: 34039752 PMCID: PMC8327315 DOI: 10.1136/practneurol-2020-002838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/15/2022]
Abstract
The widespread use of MRI has led to the increasingly frequent diagnosis of pineal and colloid cysts. While most are small and incidental, do not require long-term monitoring and will never need treatment, they are a cause of patient anxiety and clinician uncertainty regarding the optimal management-particularly for larger cysts or those with an atypical appearance. Occasionally pineal cysts, and more commonly colloid cysts, cause hydrocephalus that requires urgent neurosurgical treatment. More recently the non-hydrocephalic symptomatic pineal cyst has been described in the neurosurgical literature but there is controversy over this entity and its management. This review addresses the difficulties in managing pineal and colloid cysts and provides a pragmatic framework for the practising clinician.
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Affiliation(s)
- Michael D Jenkinson
- Clinical and Molecular Cancer, University of Liverpool, Liverpool, Merseyside, UK
- Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Samantha Mills
- Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Conor L Mallucci
- Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Thomas Santarius
- Clinical and Academic Neuroscience, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
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21
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Is there any relationship between autism and pineal gland volume? Pol J Radiol 2021; 86:e225-e231. [PMID: 34093919 PMCID: PMC8147713 DOI: 10.5114/pjr.2021.105689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Abnormalities in melatonin physiology and circadian rhythm are detected in patients with autism. Melatonin is produced predominantly in the pineal gland and the amount of melatonin released is proportional to the pineal gland volume. This study aimed to examine whether the pineal gland volume in children with autism is different from that in healthy children. Material and methods Brain magnetic resonance images (MRI) of 120 paediatric patients with autism and 82 control paediatric subjects were examined; pineal parenchymal volume (PPV), pineal cyst rate (PCR), and total pineal gland volume (TPGV) were measured using a multimodality viewer (MMV), but only the TPGVs were measured using a tumour tracking (TT) method. Measurements were taken by 2 separate radiologists. Results In patients with autism, the PPV and TPGV according to MMV, and the TPGV according to TT were significantly lower, and the PCR was significantly higher. Moreover, the ratio of PPV to TPGV was significantly lower in the autism patient group. In both groups, the TPGVs were significantly lower in the autism patient group than the controls among all age groups. Conclusions Our study was the first to examine TPGVs in detail in paediatric patients with autism using 2 different methods. Low PPV-TPGV and high PCR have been observed in autism. This study also provides comparable reference values for pineal gland size in healthy children or autistic children aged 2-17 years. These results show promising potential for further research to understand the relationship between autism pathogenesis and the pineal gland.
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22
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Gheban BA, Colosi HA, Gheban-Rosca IA, Pop B, Domșa AMT, Georgiu C, Gheban D, Crișan D, Crișan M. Age-Related Changes of the Pineal Gland in Humans: A Digital Anatomo-Histological Morphometric Study on Autopsy Cases with Comparison to Predigital-Era Studies. ACTA ACUST UNITED AC 2021; 57:medicina57040383. [PMID: 33921100 PMCID: PMC8071372 DOI: 10.3390/medicina57040383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: The pineal gland is a photoneuroendocrine organ in the midline of the brain, responsible primarily for melatonin synthesis. It is composed mainly of pinealocytes and glial tissue. This study examined human postmortem pineal glands to microscopically assess age-related changes using digital techniques, and offers a perspective on evolutionary tendencies compared to the past. Materials and Methods: A retrospective autopsy study has been performed on 72 pediatric and adult autopsy cases. The glands have been processed for histological analysis and immunohistochemical staining with glial fibrillary acidic protein (GFAP). Slides were assessed under polarized light and digitally scanned. Morphometric data were obtained using CaseViewer and ImageJ. Results: Thirty-three females and 39 males were included in the study, grouped under three age groups: 0–25, 46–65, and 66–96 years of age. The peak gland volume was found within the 46–65 age group, the overall mean volume was 519 mm3, the main architectural types were lobular and insular, and the mean percentage of pineal calcification was 15% of the gland, peaking within the 66–96 age group, with a predominantly globular shape. Glial cysts were found in 20.8% of cases. The intensity of GFAP stain was maximal in the pediatric age group, but the extent of glial tissue was much larger in elderly patients. Discussion: The degenerative process of the pineal gland can be quantified by measuring normal parenchyma, calcifications, glial tissue, and glial cysts. Morphometric differences have been observed and compared to a similar studies performed in the published literature. The current study, unfortunately, lacks a 26–45 age group. Digital techniques seemed to offer a more exact analysis, but returned similar results to studies performed over 40 years ago, therefore offering important information on evolutionary tendencies. Conclusions: Increase in glial tissue, calcifications, and glial cysts have a defining role as age-related changes in the pineal gland.
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Affiliation(s)
- Bogdan-Alexandru Gheban
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
- Correspondence: (B.-A.G.); (H.A.C.)
| | - Horațiu Alexandru Colosi
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania
- Correspondence: (B.-A.G.); (H.A.C.)
| | | | - Bogdan Pop
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- The Oncology Institute “Ion Chiricuţă”, 400015 Cluj-Napoca, Romania;
| | - Ana-Maria Teodora Domșa
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
| | - Carmen Georgiu
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
| | - Dan Gheban
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Children’s Emergency Clinical Hospital, 400000 Cluj-Napoca, Romania
| | - Doinița Crișan
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
| | - Maria Crișan
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
- Department of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania
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23
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Prevalence Rate of Coexisting Rathke Cleft Cysts and Pineal Cysts: A Multicenter Cross-Sectional Study. World Neurosurg 2021; 149:e455-e459. [PMID: 33567367 DOI: 10.1016/j.wneu.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rathke cleft cysts (RCCs) are benign sellar lesions originating from remnants of primitive ectoderm. They have not been previously linked to other cystic lesions, such as pineal cysts (PCs). Our objective was to perform a multicenter cross-sectional neuroimaging study to examine prevalence rates of coexisting RCC and PC. METHODS We retrospectively queried prospectively maintained, institutional review board-approved, databases from the authors' centers. All patients undergoing transsphenoidal surgery for RCC between the years of 2011 and 2020 were included for analysis. Preoperative magnetic resonance imaging was reviewed to identify the coexistence of a PC. Patient demographics and neuroimaging characteristics were recorded. A control cohort comprised of 100 age- and sex-matched patients with nonfunctional pituitary adenoma (NFPA) who also underwent surgical intervention was utilized. RESULTS Eighty-four patients with RCC were identified for analysis. A coexistent PC was identified in 40.5% (n = 34) of patients with RCC compared with 14.3% (n = 12) in the NFPA cohort (P < 0.001). There was no significant difference in PC size between patients with RCC and PA (8 vs. 8.8 mm, respectively; P = 0.77). Although the majority (85.7%; n = 72) of the RCC cohort were female patients, there was no sex predominance with respect to coexisting PC in either the RCC or PA cohort. CONCLUSIONS This is the first study to report an increased prevalence of coexisting PC and RCC, possibly because of an embryologic link or other propensity for intracranial cyst formation. Additional studies in more generalizable populations can further explore the relation between RCC and PC, or other cyst formation.
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Tanaka T, Arnold L, Gabriela Mazuru D, Golzy M, Carr SB, Litofsky NS. Pineal cysts: Does anyone need long-term follow up? J Clin Neurosci 2020; 83:146-151. [PMID: 33272885 DOI: 10.1016/j.jocn.2020.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
Pineal cysts are a common incidental finding on brain magnetic resonance imaging (MRI) whichfrequently prompts referral to neurosurgery. Currently, a management algorithm for patientswithout hydrocephalus, Parinaud's syndrome, or pineal apoplexy is lacking.We aimed to identifypredictive factors of pineal cyst volume change andsurgical intervention by performing retrospective chart review of 98 patients between 2005 and 2018 diagnosed with pineal cysts gleaned from our Neurosurgery clinical databases.We included patients whose initial and follow-up MRIs were available in our institutional radiology system or whose surgical pathology confirmed pineal cyst after evaluation with an initial MRI. Patients' medical records were queried for presenting symptoms, demographic, management, and pineal cyst measurements. Three dimensions (anterior-posterior, rostral-caudal, transverse) of pineal cyst size were measured and converted to cyst volume (cm3) for analysis. Fifty-five patients (mean age 26.09 ± 14.7 years) with pineal cysts met study criteria. Follow-up ranged from 4 months to 10 years. The indications for MR imaging included headache (81.8%) and vision problems (42%).Forty-eight patients who were observed had a mean volume change of 0.051 ± 0.862 cm [3] and median volume change of 0 cm [3] Patient symptoms, referral source, and age were not associated with changes in volume on follow-up. Aggregated number of symptoms did not differ between operative and observation patients. (p = 0.29). Pineal cyst volumes tend to remain stable over serial MR images, do not reliably correlate with symptoms, and do not typically require long-term follow-up.
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Affiliation(s)
- Tomoko Tanaka
- Department of Neurosurgery, University of Arkansas for Medical Science, United States; Division of Pediatric Neurosurgery, Arkansas Children's Hospital Medical Center, United States; Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States.
| | - Lauren Arnold
- University of Missouri, School of Medicine, United States
| | - Dana Gabriela Mazuru
- Department of Radiology, University of Missouri, School of Medicine, United States
| | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri, School of Medicine, United States
| | - Steven B Carr
- Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States
| | - N Scott Litofsky
- Division of Division of Neurosurgery, University of Missouri, School of Medicine, United States
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Park J, Suh SW, Kim GE, Lee S, Kim JS, Kim HS, Byun S, Bae JB, Kim JH, Kim SE, Han JW, Kim KW. Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2020; 12:157. [PMID: 33220712 PMCID: PMC7680594 DOI: 10.1186/s13195-020-00725-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer's disease (AD) patients without any feature of dementia with Lewy bodies. METHODS We enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on 18F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging. RESULTS The participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p < 0.001). The smaller the VPP, the more severe the RBD symptoms (p < 0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878-0.942, p < 0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750-0.844, p < 0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately. CONCLUSIONS In AD patients, reduced pineal gland volume may be associated with RBD.
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Affiliation(s)
- Jeongbin Park
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Seung Wan Suh
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Grace Eun Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Subin Lee
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Jun Sung Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Hye Sung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea. .,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea. .,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
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Lukewich MK, Alshafai L, Micieli JA. Spontaneous Resolution of Dorsal Midbrain Syndrome Caused by a Pineal Cyst. World Neurosurg 2020; 136:289-292. [PMID: 32001401 DOI: 10.1016/j.wneu.2020.01.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pineal lesions are common causes of dorsal midbrain syndrome and typically require surgical intervention in symptomatic patients. We describe a unique case of spontaneous resolution of dorsal midbrain syndrome resulting from a pineal gland cyst. CASE DESCRIPTION A 23-year-old woman developed a supranuclear upgaze palsy, convergence-retraction nystagmus, and light-near dissociation from a pineal gland cyst (1.0 × 1.3 × 1.2 cm) with mild mass effect on the posterior surface of the tectum. Seven days after symptom onset, she had complete, spontaneous resolution of her symptoms, and examination returned to normal. Repeat magnetic resonance imaging demonstrated an unchanged pineal cyst with new T2/fluid attenuated inversion recovery hyperintensity along the mesial surface of the left thalamus. CONCLUSIONS Dorsal midbrain syndrome resulting from a pineal cyst may spontaneously improve even without a significant change in lesion size. This suggests that observation may be an appropriate initial management strategy.
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Affiliation(s)
- Mark K Lukewich
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laila Alshafai
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Centre, Toronto, Ontario, Canada.
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27
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Park J, Han JW, Suh SW, Byun S, Han JH, Bae JB, Kim JH, Kim KW. Pineal gland volume is associated with prevalent and incident isolated rapid eye movement sleep behavior disorder. Aging (Albany NY) 2020; 12:884-893. [PMID: 31918412 PMCID: PMC6977654 DOI: 10.18632/aging.102661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/24/2019] [Indexed: 04/25/2023]
Abstract
We aimed to investigate the association of pineal gland volume with the risk of isolated rapid eye movement (REM) sleep behavior disorder (RBD). We enrolled 245 community-dwelling cognitively normal elderly individuals without major psychiatric or neurological disorders at the baseline evaluation, of whom 146 completed the 2-year follow-up evaluation. We assessed RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as an RBDSQ score of ≥ 5. We manually segmented the pineal gland on 3T T1-weighted brain magnetic resonance imaging and estimated its volume. The smaller the baseline pineal gland volume, the more severe the RBD symptoms at baseline. The individuals with isolated pRBD showed smaller pineal gland volumes than those without isolated pRBD. The larger the baseline pineal gland volume, the lower the risks of prevalent isolated pRBD at the baseline evaluation and incident isolated pRBD at the 2-year follow-up evaluation. Pineal gland volume showed good diagnostic accuracy for prevalent isolated pRBD and predictive accuracy for incident isolated pRBD in the receiver operator characteristic analysis. Our findings suggest that pineal gland volume may be associated with the severity of RBD symptoms and the risk of isolated RBD in cognitively normal elderly individuals.
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Affiliation(s)
- Jeongbin Park
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Takahashi T, Sasabayashi D, Yücel M, Whittle S, Lorenzetti V, Walterfang M, Suzuki M, Pantelis C, Malhi GS, Allen NB. Pineal Gland Volume in Major Depressive and Bipolar Disorders. Front Psychiatry 2020; 11:450. [PMID: 32528324 PMCID: PMC7256967 DOI: 10.3389/fpsyt.2020.00450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/04/2020] [Indexed: 12/27/2022] Open
Abstract
Abnormal melatonin secretion has been demonstrated in patients with affective disorders such as major depressive disorder (MDD) and bipolar disorder (BD). However, magnetic resonance imaging (MRI) studies that previously investigated the volume of the pineal gland, which regulates circadian rhythms by secreting melatonin, in these patients reported inconsistent findings. The present study employed MRI to examine pineal gland volumes and pineal cyst prevalence in 56 MDD patients (29 currently depressed and 27 remitted patients), 26 BD patients, and matched controls (33 for MDD and 24 for BD). Pineal volumes and cyst prevalence in the current MDD, remitted MDD, and BD groups did not significantly differ from those of the healthy controls. However, pineal gland volumes were significantly smaller in the current MDD subgroup of non-melancholic depression than in the melancholic MDD subgroup. Interestingly, pineal volumes correlated negatively with the severity of loss of interest in the current MDD group. Medication and the number of affective episodes were not associated with pineal volumes in the MDD or BD group. While these results do not suggest that pineal volumes reflect abnormal melatonin secretion in affective disorders, they do point to the possibility that pineal abnormalities are associated with clinical subtypes of MDD and its symptomatology.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama School of Medicine, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama School of Medicine, Toyama, Japan
| | - Murat Yücel
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- Faculty of Health Sciences, School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Mark Walterfang
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.,Department of Neuropsychiatry, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama School of Medicine, Toyama, Japan
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Gin S Malhi
- Discipline of Psychological Medicine, Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicholas B Allen
- Department of Psychology, University of Oregon, Eugene, OR, United States
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Park J, Han JW, Lee JR, Byun S, Suh SW, Kim T, Yoon IY, Kim KW. Lifetime coffee consumption, pineal gland volume, and sleep quality in late life. Sleep 2019; 41:5053876. [PMID: 30011049 DOI: 10.1093/sleep/zsy127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Indexed: 12/22/2022] Open
Abstract
Study Objectives Previous studies have shown that coffee consumption may suppress the production of melatonin in pinealocytes through competitive inhibition of adenosine A2 receptors by caffeine. We investigated the impact of lifetime coffee consumption on pineal gland volume and the resulting effects on sleep quality. Methods We enrolled 162 cognitively normal elderly individuals among the participants in the Korean Longitudinal Study on Cognitive Aging and Dementia. We evaluated the patterns and amounts of coffee consumption using a study-specific standardized interview and assessed sleep quality using the Pittsburgh Sleep Quality Index. We measured the volume of pineal parenchyma (VPP) by manually segmenting the pineal gland on high-resolution three-dimensional T1-weighted magnetic resonance images. We examined the impact of lifetime coffee consumption on the VPP and the resulting effects on sleep quality using analysis of covariance, multiple linear regression, and mediation analyses. Results We found that smaller VPP was associated with higher cumulative lifetime coffee consumption. Participants who consumed more than 60 cup-years of coffee had VPPs that were smaller by about 20% than individuals who consumed less than 60 cup-years of coffee. The VPP mediated the association between lifetime coffee consumption and sleep efficiency and quality. Conclusions Our findings suggest that high lifetime coffee consumption may reduce VPP, and that this reduction in VPP may impair the quality of sleep in late life.
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Affiliation(s)
- Jeongbin Park
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju Ri Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae Kim
- Department of Biomedical Science and Engineering and School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - In Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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30
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Pineal Cyst without Hydrocephalus: Clinical Presentation and Postoperative Clinical Course After Infratentorial Supracerebellar Resection. World Neurosurg 2019; 129:e530-e537. [DOI: 10.1016/j.wneu.2019.05.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/24/2022]
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Peres MF, Valença MM, Amaral FG, Cipolla-Neto J. Current understanding of pineal gland structure and function in headache. Cephalalgia 2019; 39:1700-1709. [PMID: 31370669 DOI: 10.1177/0333102419868187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The pineal gland plays an important role in biological rhythms, circadian and circannual variations, which are key aspects in several headache disorders. OVERVIEW Melatonin, the main pineal secreting hormone, has been extensively studied in primary and secondary headache disorders. Altered melatonin secretion occurs in many headache syndromes. Experimental data show pineal gland and melatonin both interfere in headache animal models, decreasing trigeminal activation. Melatonin has been shown to regulate CGRP and control its release. DISCUSSION Melatonin has been used successfully as a treatment for migraine, cluster headaches and other headaches. There is a rationale for including the pineal gland as a relevant brain structure in the mechanisms of headache pathophysiology, and melatonin as a treatment option in primary headache.
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Affiliation(s)
- Mario Fp Peres
- Hospital Israelita Albert Einstein, Sao Paolo, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Pernambuco, Brazil
| | | | | | - José Cipolla-Neto
- Instituto de Ciencias Biomédicas, Universidade de São Paulo, São Paulo, Brazil
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Gheban BA, Rosca IA, Crisan M. The morphological and functional characteristics of the pineal gland. Med Pharm Rep 2019; 92:226-234. [PMID: 31460502 PMCID: PMC6709953 DOI: 10.15386/mpr-1235] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/20/2019] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The pineal gland is a photo-neuro-endocrine organ situated inside the brain, that secretes serotonin, melatonin and N,N-dymethyltriptamine. This narrative review will address the latest information gathered on this function of the gland as well as the unknown roles it may have. The different histological and pathological findings of the pineal gland have demonstrated a role in clinical manifestations of numerous endocrine, neurological and psychiatric pathologies. Materials For this narrative review we used the NCBI website database PubMed. The search terms were “Pineal Gland” AND/OR “histology, melatonin, DMT, pathology”. Total number of articles included were 86. Results We have reviewed physiological information of melatonin and DMT, anatomical, histological and histopathological information on the pineal gland and its role in endocrine, neurological and psychiatric pathology. Conclusion The role of melatonin in immunity and its potential therapeutic effects show promising potential for further research. DMT seems to have a role in psychiatric pathology and potential therapeutic effects. Proper tumoral screening and diagnostic protocol are required.
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Affiliation(s)
- Bogdan Alexandru Gheban
- Morphological Sciences Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ioana Andreea Rosca
- Radiotherapy Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Maria Crisan
- Histology and Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
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Zhao W, Zhu DM, Zhang Y, Zhang C, Wang Y, Yang Y, Bai Y, Zhu J, Yu Y. Pineal gland abnormality in major depressive disorder. Psychiatry Res Neuroimaging 2019; 289:13-17. [PMID: 31121531 DOI: 10.1016/j.pscychresns.2019.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 01/16/2023]
Abstract
Patients with major depressive disorder (MDD) often have circadian rhythm alteration and sleep disturbance. The pineal gland regulates the circadian rhythm and sleep by the secretion of melatonin neurohormone. However, the relationship between pineal abnormality and MDD remains elusive. 50 patients with MDD and 35 gender- and age-matched healthy controls underwent high-resolution structural MRI. Pineal parenchymal volume (PPV) was measured manually. Inter-group differences in prevalence of pineal cyst and PPV were examined. In addition, we investigated the correlations between PPV and symptom severity as well as sleep variables in the patient group. Compared to healthy controls, patients with MDD had a higher prevalence of pineal cyst. Moreover, patients had significantly decreased PPV relative to controls. However, no significant correlations were observed between PPV and symptom severity as well as sleep variables. Our findings suggest that pineal abnormality may play a critical role in depression.
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Affiliation(s)
- Wenming Zhao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Dao-Min Zhu
- Department of Sleep Disorders, Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Yu Zhang
- Department of Sleep Disorders, Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Cun Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yajun Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Ying Yang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Ya Bai
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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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: 1.5] [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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Matsuoka T, Imai A, Fujimoto H, Kato Y, Shibata K, Nakamura K, Yokota H, Yamada K, Narumoto J. Neural Correlates of Sleep Disturbance in Alzheimer's Disease: Role of the Precuneus in Sleep Disturbance. J Alzheimers Dis 2019; 63:957-964. [PMID: 29710710 PMCID: PMC6004892 DOI: 10.3233/jad-171169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Sleep disturbance may affect the development of Alzheimer’s disease (AD), but the neural correlates of sleep disturbance in AD have not been fully clarified. Objective: To examine the factors associated with sleep disturbance in AD. Methods: A retrospective study was performed in 63 patients with AD. None of the patients had been prescribed antidementia or psychoactive drugs, and all underwent brain magnetic resonance imaging (MRI) before medication. Sleep disturbance was defined as a score of at least 1 point on the sleep disturbance subscale of the Neuropsychiatric Inventory (NPI). Whole brain image analysis was performed using SPM8 and VBM8. A two-sample t-test was used to compare patients with AD with (n = 19) and without (n = 44) sleep disturbance, with age and gender included as covariates. The statistical thresholds were set to an uncorrected p-value of 0.001 at the voxel level and a corrected p-value of 0.05 at the cluster level. In addition, pineal gland volume (PGV) measured using MRI, and white matter hyperintensity (WMH) assessed with the modified Fazekas scale were compared between patients with AD with and without sleep disturbance using independent group t-tests. Results: In whole brain analysis, the precuneus volume in patients with AD with sleep disturbance was significantly smaller than those without sleep disturbance. There were no significant differences in PGV and WMH between the two groups. Conclusion: Sleep disturbance in AD was associated with reduction of precuneus volume. This suggests that the precuneus might be an important region in sleep disturbance in AD.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keisuke Shibata
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Yokota
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Takahashi T, Nakamura M, Sasabayashi D, Nishikawa Y, Takayanagi Y, Nishiyama S, Higuchi Y, Furuichi A, Kido M, Noguchi K, Suzuki M. Reduced pineal gland volume across the stages of schizophrenia. Schizophr Res 2019; 206:163-170. [PMID: 30527931 DOI: 10.1016/j.schres.2018.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Abstract
A few magnetic resonance imaging (MRI) studies reported reduced pineal gland volume in chronic schizophrenia (Sz), implicating the involvement of melatonin in the pathophysiology of the illness. However, it is not known whether this abnormality, if present, exists at the early illness stages and/or develops progressively over the course of the illness. This MRI study examined pineal gland volume in 64 patients with first-episode schizophrenia (FESz), 40 patients with chronic Sz, 22 individuals with at-risk mental state (ARMS), and 84 healthy controls. Longitudinal changes in pineal volume (mean inter-scan interval = 2.5 ± 0.7 years) were also examined in a subsample of 23 FESz, 16 chronic Sz, and 21 healthy subjects. In the cross-sectional comparison, the ARMS, FESz, and chronic Sz groups had significantly smaller pineal volume to the same degree as compared with healthy controls. A longitudinal comparison demonstrated that pineal volume did not change over time in any group. There was no association between pineal volume and clinical variables (e.g., symptom severity, medication) in the ARMS and Sz groups. The results suggest that a smaller pineal gland may be a static vulnerability marker of Sz, which probably reflects an early neurodevelopmental abnormality.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - Mihoko Nakamura
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yumiko Nishikawa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Shimako Nishiyama
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yuko Higuchi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bisdas S, D’Arco F. Pediatric Tumor Neuroradiology. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Maruani A, Dumas G, Beggiato A, Traut N, Peyre H, Cohen-Freoua A, Amsellem F, Elmaleh M, Germanaud D, Launay JM, Bourgeron T, Toro R, Delorme R. Morning Plasma Melatonin Differences in Autism: Beyond the Impact of Pineal Gland Volume. Front Psychiatry 2019; 10:11. [PMID: 30787884 PMCID: PMC6372551 DOI: 10.3389/fpsyt.2019.00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022] Open
Abstract
While low plasma melatonin, a neuro-hormone synthesized in the pineal gland, has been frequently associated with autism, our understanding of the mechanisms behind it have remained unclear. In this exploratory study, we hypothesized that low melatonin levels in ASD could be linked to a decrease of the pineal gland volume (PGV). PGV estimates with magnetic resonance imaging (MRI) with a voxel-based volumetric measurement method and early morning plasma melatonin levels were evaluated for 215 participants, including 78 individuals with ASD, 90 unaffected relatives, and 47 controls. We first found that both early morning melatonin level and PGV were lower in patients compared to controls. We secondly built a linear model and observed that plasma melatonin was correlated to the group of the participant, but also to the PGV. To further understand the relationship between PGV and melatonin, we generated a normative model of the PGV relationship with melatonin level based on control participant data. We found an effect of PGV on normalized melatonin levels in ASD. Melatonin deficit appeared however more related to the group of the subject. Thus, melatonin variations in ASD could be mainly driven by melatonin pathway dysregulation.
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Affiliation(s)
- Anna Maruani
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Guillaume Dumas
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Anita Beggiato
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Nicolas Traut
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Hugo Peyre
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Alicia Cohen-Freoua
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Frédérique Amsellem
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Monique Elmaleh
- Pediatric Radiology Department, Robert Debré Hospital, Paris, France
| | - David Germanaud
- Department of Pediatric Neurology, Robert Debré Hospital, AP-HP, Paris, France.,Neuropaediatric Team, UNIACT, NeuroSpin, CEA-Saclay, Gif-sur-Yvette, France
| | - Jean-Marie Launay
- Biochemistry Department, INSERM U942, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris EA 3621, Paris, France
| | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Roberto Toro
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K, Price R, Williams CS, Orrison WW, Patel JB, Walker JM, Meehan A, Mirow S, the NORMAL Study Team. Comprehensive Evaluation of Healthy Volunteers Using Multi-Modality Brain Injury Assessments: An Exploratory, Observational Study. Front Neurol 2018; 9:1030. [PMID: 30631299 PMCID: PMC6315163 DOI: 10.3389/fneur.2018.01030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: Even though mild traumatic brain injury is common and can result in persistent symptoms, traditional measurement tools can be insensitive in detecting functional deficits after injury. Some newer assessments do not have well-established norms, and little is known about how these measures perform over time or how cross-domain assessments correlate with one another. We conducted an exploratory study to measure the distribution, stability, and correlation of results from assessments used in mild traumatic brain injury in healthy, community-dwelling adults. Materials and Methods: In this prospective cohort study, healthy adult men and women without a history of brain injury underwent a comprehensive brain injury evaluation that included self-report questionnaires and neurological, electroencephalography, sleep, audiology/vestibular, autonomic, visual, neuroimaging, and laboratory testing. Most testing was performed at 3 intervals over 6 months. Results: The study enrolled 83 participants, and 75 were included in the primary analysis. Mean age was 38 years, 58 were male, and 53 were civilians. Participants did not endorse symptoms of post-concussive syndrome, PTSD, or depression. Abnormal neurological examination findings were rare, and 6 had generalized slowing on electroencephalography. Actigraphy and sleep diary showed good sleep maintenance efficiency, but 21 reported poor sleep quality. Heart rate variability was most stable over time in the sleep segment. Dynavision performance was normal, but 41 participants had abnormal ocular torsion. On eye tracking, circular, horizontal ramp, and reading tasks were more likely to be abnormal than other tasks. Most participants had normal hearing, videonystagmography, and rotational chair testing, but computerized dynamic posturography was abnormal in up to 21% of participants. Twenty-two participants had greater than expected white matter changes for age by MRI. Most abnormal findings were dispersed across the population, though a few participants had clusters of abnormalities. Conclusions: Despite our efforts to enroll normal, healthy volunteers, abnormalities on some measures were surprisingly common. Trial Registration: This study was registered at www.clinicaltrials.gov, trial identifier NCT01925963.
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Affiliation(s)
- Lindell K. Weaver
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, United States
- Intermountain LDS Hospital, Salt Lake City, UT, United States
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | | | | | - Susan Churchill
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, United States
- Intermountain LDS Hospital, Salt Lake City, UT, United States
| | - Kayla Deru
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, United States
- Intermountain LDS Hospital, Salt Lake City, UT, United States
| | - Robert Price
- Evans Army Community Hospital, Fort Carson, CO, United States
| | | | | | - Jigar B. Patel
- Lovelace Biomedical Research, Albuquerque, NM, United States
| | - James M. Walker
- Lovelace Biomedical Research, Albuquerque, NM, United States
| | - Anna Meehan
- Lovelace Biomedical Research, Albuquerque, NM, United States
| | - Susan Mirow
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Lovelace Biomedical Research, Albuquerque, NM, United States
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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: 21] [Impact Index Per Article: 3.0] [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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Bezuidenhout AF, Kasper EM, Baledent O, Rojas R, Bhadelia RA. Relationship between pineal cyst size and aqueductal CSF flow measured by phase contrast MRI. J Neurosurg Sci 2018; 65:63-68. [PMID: 29480683 DOI: 10.23736/s0390-5616.18.04258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most patients with pineal cysts referred for neurosurgical consultation have no specific symptoms or objective findings except for pineal cyst size to help in management decisions. Our purpose was to assess the relationship between pineal cyst size and aqueductal CSF flow using PC-MRI. METHODS Eleven adult patients with pineal cysts (>1 cm) referred for neurosurgical consultations were included. Cyst volume was calculated using 3D T1 images. Phase contrast magnetic resonance imaging (PC-MRI) in axial plane with velocity encoding of 5 cm/sec was used to quantitatively assess CSF flow through the cerebral aqueduct to determine the aqueductal stroke volume, which was then correlated to cyst size using Pearson's correlation. Pineal cysts were grouped by size into small (6/11) and large (5/11) using the median value to compare aqueductal stroke volume using Mann-Whitney test. RESULTS Patients were 39±13 years (mean±SD) of age, and 10/11 (91%) were female. There was significant negative correlation between cyst volume and aqueductal stroke volume (r=0.74; P=0.009). Volume of small cysts (4954±2157 mm3) was significantly different compared to large cysts (13,752±3738 mm3; P=0.008). The aqueductal stroke volume of patients harboring large cysts 33±8 μL/cardiac cycle was significantly lower than that of patients with small cysts 96±29 μL/cardiac cycle (P=0.008). CONCLUSIONS Aqueductal CSF flow appears to decrease with increasing pineal cyst size. Our preliminary results provide first evidence that even in the absence of objective neurological findings or hydrocephalus; larger pineal cysts already display decreased CSF flow through the cerebral aqueduct.
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Affiliation(s)
| | - Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Olivier Baledent
- Department of Imaging and Biophysics, Amiens-Picardy Nord University Hospital, Amiens, France
| | - Rafael Rojas
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Bosnjak J, Butkovic SS, Miskov S, Coric L, Jadrijevic-Tomas A, Mejaski-Bosnjak V. Epilepsy in patients with pineal gland cyst. Clin Neurol Neurosurg 2018; 165:72-75. [PMID: 29324398 DOI: 10.1016/j.clineuro.2017.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/06/2017] [Accepted: 12/28/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of the study is to describe types of epileptic seizures in patients with pineal gland cyst (PGC) and their outcome during follow up period (6-10 years). We wanted to determine whether patients with epilepsy differ in PGC volume and compression of the PGC on surrounding brain structures compared to patients with PGC, without epilepsy. PATIENTS AND METHODS We analyzed prospectivelly 92 patients with PGC detected on magnetic resonance (MR) of the brain due to various neurological symptoms during the period 2006-2010. Data on described compression of the PGC on surrounding brain structures and size of the PGC were collected. RESULTS 29 patients (16 women, 13 men), mean age 21.17 years had epilepsy and PGC (epilepsy group). 63 patients (44 women, 19 men), mean age 26.97 years had PGC without epilepsy (control group). Complex partial seizures were present in 8 patients, complex partial seizures with secondary generalization in 8 patients, generalized tonic clonic seizures (GTCS) in 10 and absance seizures in 3 patients. Mean PGC volume in epilepsy group was 855.93 mm3, in control group 651.59 mm3. There was no statistically significant difference between epilepsy and control group in PGC volume. Compression of PGC on surrounding brain structures was found in 3/29 patients (10.34%) in epilepsy group and in 11/63 patients (17.46%) in control group with no statistically significant difference between epilepsy and control group. All patients with epilepsy were put on antiepileptic therapy (AET). During the follow up period, 23 patients (79.31%) were seizure free, 3 patients (13.04%) had reduction in seizure frequency, whereas 3 patients had no improvement in seizure frequency. Two patients from epilepsy group and 3 patients from control group were operated with histologically confirmed diagnosis of PGC in 4, and pinealocytoma in 1 patient. CONCLUSIONS In patients with PGC, epileptic seizures were classified as: complex partial seizures (with or without secondary generalization), GTCS and absance seizures. All patients were put on AET. During follow up period 79.31% patients were seizure free. There was no difference in PGC volume, nor in described compression of the PGC on surrounding brain structures between epilepsy and control group. Based on our findings, pathomechanism of epileptic seizures in patients with PGC cannot be attributable solely to PGC volume or described compression on surrounding brain structures based on MRI findings.
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Affiliation(s)
- Jelena Bosnjak
- Department of Neurology, University Hospital, Sestre milosrdnice, Zagreb, Croatia.
| | - Silva Soldo Butkovic
- Department of Neurology, University Hospital Osijek, School of Medicine, University of Osijek, Osijek, Croatia
| | - Snjezana Miskov
- Department of Neurology, University Hospital, Sestre milosrdnice, Zagreb, Croatia
| | - Lejla Coric
- Department of Neurology, University Hospital, Sestre milosrdnice, Zagreb, Croatia
| | - Ana Jadrijevic-Tomas
- Department of Neurology, University Hospital, Sestre milosrdnice, Zagreb, Croatia
| | - Vlatka Mejaski-Bosnjak
- Department of Neuropediatrics, Children's Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
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Arenas RM, Shoemaker JM, Phillips J. High prevalence of pineal cysts in adults who stutter. BRAIN AND LANGUAGE 2018; 177-178:18-22. [PMID: 29421268 DOI: 10.1016/j.bandl.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Richard M Arenas
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States.
| | | | - John Phillips
- Mind Research Network, Albuquerque, NM, United States; Department of Neurology, University of New Mexico Health Sciences, United States
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Abstract
PURPOSE OF REVIEW Intracranial cysts are common findings on both CT and MRI. The majority of intracranial cysts are benign and incidental and without clinical significance. However, a minority are due to infectious, neoplastic, or other pathologic processes. RECENT FINDINGS Neuroimaging, in particular brain MRI, can readily identify intracranial cysts. It can often be difficult to characterize the likely histopathology of intracranial cysts based solely on their signal intensity, even when using contrast. However, with the knowledge that most intracranial cysts occur within a fairly narrow anatomic distribution, a concise and specific differential diagnosis can often be developed based primarily on location. The first location-based question to consider regarding intracranial cysts is whether the lesion is intraaxial or extraaxial. Intraaxial cysts should be further characterized as intraparenchymal or intraventricular, and extraaxial cysts should be identified as either midline or nonmidline. Signal characteristics using CT, MRI, or both can help further characterize the cystic process. SUMMARY Neurologists should be familiar with the characteristic patterns of intracranial cysts to distinguish between benign and pathologic processes. A systematic approach to the assessment of intracranial cysts based on location and appearance should greatly narrow the differential diagnosis.
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Matsuoka T, Imai A, Fujimoto H, Kato Y, Shibata K, Nakamura K, Yokota H, Yamada K, Narumoto J. Reduced Pineal Volume in Alzheimer Disease: A Retrospective Cross-sectional MR Imaging Study. Radiology 2018; 286:239-248. [DOI: 10.1148/radiol.2017170188] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Teruyuki Matsuoka
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Ayu Imai
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Hiroshi Fujimoto
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Yuka Kato
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Keisuke Shibata
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Kaeko Nakamura
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Hajime Yokota
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Kei Yamada
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
| | - Jin Narumoto
- From the Departments of Psychiatry (T.M., A.I., H.F., Y.K., K.S., K.N., J.N.) and Radiology (H.Y., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.Y.)
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Jussila MP, Olsén P, Salokorpi N, Suo-Palosaari M. Follow-up of pineal cysts in children: is it necessary? Neuroradiology 2017; 59:1265-1273. [PMID: 28942520 DOI: 10.1007/s00234-017-1926-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Pineal cysts are common incidental findings in children undergoing magnetic resonance imaging (MRI). Several studies have suggested MRI follow-up if the cyst is larger than 10 mm. However, cysts do not usually change during follow-up. Prevalence, growth, and structure of the pineal cysts were analyzed to decide if follow-up MRI is necessary. METHODS A retrospective review between 2010 and 2015 was performed using 3851 MRI examinations of children aged 0-16 years to detect pineal cysts having a maximum diameter ≥ 10 mm. Eighty-one children with pineal cysts were identified and 79 of them had been controlled by MRI. Cysts were analyzed for the size, growth, and structure. RESULTS A total of 1.8% of the children had a pineal cyst with a diameter ≥ 10 mm. Cysts were present in 48 girls (59.3%) and 33 boys (40.7%). Most pineal cysts (70/79) did not significantly grow during the follow-up (median 10 months, range 3-145 months). A total of 11.4% (9/79) of the cysts grew with the biggest change measured from the outer cyst wall sagittal anteroposterior dimension (mean 3.4 mm ± 1.7 mm). Only one cyst grew more than 5 mm. We found no factors correlating with the cyst growth among 9 cysts that grew > 2 mm. CONCLUSIONS A majority of pineal cysts remained unchanged during the MRI follow-up. Results of this study suggest that routine MRI 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)
- Miro-Pekka Jussila
- Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, P.O. Box 50, OYS, Oulu, 90029, Finland
- Department of Children and Adolescents, Oulu University Hospital and University of Oulu, P.O. Box 23, OYS, Oulu, 90029, Finland
| | - Päivi Olsén
- Department of Children and Adolescents, Oulu University Hospital and University of Oulu, P.O. Box 23, OYS, Oulu, 90029, Finland
- PEDEGO Research Group, Medical Research Center, University of Oulu, Oulu, Finland
| | - Niina Salokorpi
- Department of Neurosurgery, Oulu University Hospital and University of Oulu, P.O. Box 21, OYS, Oulu, 90029, Finland
- Medical Research Center, University of Oulu, Oulu, Finland
| | - Maria Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, P.O. Box 50, OYS, Oulu, 90029, Finland.
- Medical Research Center, University of Oulu, Oulu, Finland.
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Normal neuroanatomical variants that may be misinterpreted as disease entities. Clin Radiol 2017; 72:810-825. [PMID: 28747250 DOI: 10.1016/j.crad.2017.06.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/12/2017] [Accepted: 06/19/2017] [Indexed: 12/23/2022]
Abstract
Variations of normal development and benign incidental anomalies are frequently observed on diagnostic neuroimaging. It is important these are recognised for what they are, as misinterpretation may result in unnecessary further investigation, follow-up imaging and anxiety. In this article, we review benign intracranial anomalies commonly referred to our unit for specialist neuroradiology advice or multidisciplinary discussion, concerning cysts of the pineal gland and pituitary fossa, vascular anomalies, and perivascular spaces. This article outlines the embryology and development, the various imaging features as well as the clinical relevance and differential diagnoses of each normal neuroanatomical variant.
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50
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Eide PK, Ringstad G. Results of surgery in symptomatic non-hydrocephalic pineal cysts: role of magnetic resonance imaging biomarkers indicative of central venous hypertension. Acta Neurochir (Wien) 2017; 159:349-361. [PMID: 27878615 DOI: 10.1007/s00701-016-3029-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND We have previously proposed that pineal cysts (PCs) may result in crowding of the pineal recess, causing symptoms due to compression of the internal cerebral veins and central venous hypertension. In the present study, we compared clinical outcome of different treatment modalities in symptomatic individuals with non-hydrocephalic PCs. METHODS The study included all patients managed surgically for non-hydrocephalic PCs in our Department of Neurosurgery over a 10-year period. We applied a questionnaire to determine occurrence of symptoms before and after surgery, which allowed the use of a grading scale for symptom severity. Magnetic resonance imaging (MRI) biomarkers indicative of central venous hypertension were assessed before and after surgery. RESULTS Relief of symptoms after surgery was most efficiently obtained by complete microsurgical cyst removal [n = 15; no (0/15), some (1/15) or marked (14/15) improvement], and to a lesser extent by microsurgical cyst fenestration [n = 6; no (2/6), some (4/6) or marked (0/6) improvement]. Shunt surgery was not successful [n = 6; no (5/6), some (1/6) or marked (0/6) improvement]. In all patients, the proposed MRI biomarkers gave evidence of central venous hypertension (PC grades 2-4). CONCLUSIONS Microsurgical cyst removal provided marked symptom relief in symptomatic individuals with non-hydrocephalic PCs and MRI biomarkers of central venous hypertension. The hypothesis that PC-induced crowding of the pineal recess may compromise venous run-off and induce a central venous hypertension syndrome deserves further study.
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Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Postboks 4950, Nydalen, 0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Geir Ringstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, Oslo, Norway
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