Apart from these rare symptoms, the association between symptoms and PCL is extremely difficult to prove ( 7). In some patients, PCL can exert a mass effect on surrounding tissues, causing Parinaud's syndrome, obstructive hydrocephalus or signs of increased intracranial pressure (ICP) ( 1, 5). PCL are often asymptomatic ( 2, 4), but may present with neurological symptoms and signs such as headache, seizures, dizziness, visual disturbances, hemiparesis ( 2, 4) and sleep disturbances ( 8). In children, PCL occur on 1.9% of intracranial images ( 2, 3). In adults, the estimated prevalence ranges from 1.0 to 4.3% ( 3) and is slightly higher in women ( 4– 7). Pineal cystic lesions (PCL) are small lesions that are usually discovered incidentally by brain imaging ( 1, 2). The primary function of the pineal gland is to regulate circadian and seasonal rhythms through melatonin secretion, but it is also involved in the onset of puberty and the activity of the sex glands ( 1). A PCL larger than 20 mm and signs of increased ICP were identified as potential markers for selecting patients at risk. Only 2 PCL enlarged during the study period, both 20mm in diameter both showed signs of increased ICP, one patient was found to have a germinoma of the pineal region, while the other had no neoplasm.Ĭonclusions: Most PCL do not change their features during radiological follow-up and even atypical PCL are very rarely associated with a malignant neoplasm of the pineal region.

Six children underwent surgery – pineocytoma was confirmed in two cases and germinoma in one (2/3 of these children had signs of increased intracranial pressure (ICP), while PCL was benign in the remaining 4 cases. Pineocytoma was suspected in 31 children (21.7%). Results: The cohort consisted of 143 children with PCL. We analyzed indications for referral to a neurologist, clinical signs and symptoms, radiological features, treatment and outcome. Methods: In this observational, cohort study, children treated at University Children's Hospital, Ljubljana, Slovenia in the period 1997–2016 were included if PCL was found on brain imaging. In addition, the prevalence of PCL in the pediatric population of Slovenia was estimated. Objectives: The aim of our study was to evaluate the clinical presentation and radiological features of PCL in a cohort of pediatric patients and to identify clinical parameters more commonly associated with neoplasms in the pineal region.

In the absence of evidence-based guidelines, optimal diagnostic and therapeutic approaches have not been established, and there is a risk of under- or overtreatment of these patients. 4Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Sloveniaīackground: With the increasing availability and advances in brain imaging, pineal cyst lesions (PCL) are becoming a common finding in the pediatric population.3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.2Department of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.1Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.Ula Arkar 1 † Rok Kučan 1 † Mirjana Perković Benedik 1 Tadeja Hostnik 1 Tina Vipotnik Vesnaver 2 Tanja Loboda 1 Roman Bošnjak 3 Damjan Osredkar 1,4 *

Incidental pineal cyst