Systematic review of pineal cysts surgery in pediatric patients
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REVIEW ARTICLE
Systematic review of pineal cysts surgery in pediatric patients Joham Choque-Velasquez 1,2 & Roberto Colasanti 3,4 & Szymon Baluszek 5,6 & Julio Resendiz-Nieves 1 & Sajjad Muhammad 1,7 & Christopher Ludtka 8 & Juha Hernesniemi 1,2 Received: 21 April 2020 / Accepted: 3 July 2020 # The Author(s) 2020
Abstract Introduction We present a consecutive case series and a systematic review of surgically treated pediatric PCs. We hypothesized that the symptomatic PC is a progressive disease with hydrocephalus at its last stage. We also propose that PC microsurgery is associated with better postoperative outcomes compared to other treatments. Methods The systematic review was conducted in PubMed and Scopus. No clinical study on pediatric PC patients was available. We performed a comprehensive evaluation of the available individual patient data of 43 (22 case reports and 21 observational series) articles. Results The review included 109 patients (72% females). Ten-year-old or younger patients harbored smaller PC sizes compared to older patients (p < 0.01). The pediatric PCs operated on appeared to represent a progressive disease, which started with unspecific symptoms with a mean cyst diameter of 14.5 mm, and progressed to visual impairment with a mean cyst diameter of 17.8 mm, and hydrocephalus with a mean cyst diameter of 23.5 mm in the final stages of disease (p < 0.001). Additionally, 96% of patients saw an improvement in their symptoms or became asymptomatic after surgery. PC microsurgery linked with superior gross total resection compared to endoscopic and stereotactic procedures (p < 0.001). Conclusions Surgically treated pediatric PCs appear to behave as a progressive disease, which starts with cyst diameters of approximately 15 mm and develops with acute or progressive hydrocephalus at the final stage. PC microneurosurgery appears to be associated with a more complete surgical resection compared to other procedures. Keywords Microneurosurgery . Pineal cysts . Sitting position . Supracerebellar infratentorial approach
Introduction The prevalence of benign pineal cysts (PCs) ranges between 0.6 and 23% in the general population [1–7], and is as high as 40% in autoptic series [8]. This large range in reported prevalence is explained by the different types of MRI machine
used for the respective studies, the different methods used in defining PC size, and the various types of design and population studies [1–7, 9]. One large study on children and young people in particular showed a PC prevalence of 2% in people under 25 years of age [2]. PCs in the general population are mostly considered normal anatomical variations and the
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04792-3) contains supplementary material, which is available to authorized users. * Joham Choque-Velasquez [email protected] 1
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Department of Neurosurgery, University of Helsinki and Helsinki University Hospital Helsinki, Helsinki, Finland Juha Hernesniemi International Ce
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