Pineal Cysts: Worth a Second Look

Neurosurgeon identifies a novel constellation of symptoms that resolve upon excision of pineal cysts or cytomas

The pineal gland, a fingertip-sized structure located deep in the center of the brain, is found in almost all vertebrates, and yet its function, if any, remains a mystery. Philosophers and mystics have sometimes magnified its importance, while medical science had long since dismissed it as a vestigial gland of little significance, the neurological equivalent of the appendix.

This has left little clinical recourse to patients with pineal cysts who are experiencing symptoms such as headaches, double vision or nausea for which there is no other neurological explanation. Some patients are referred for psychiatric evaluation with the suspicion that the symptoms are psychosomatic. Others are left to seek relief for their symptoms one by one by seeing a variety of specialists. 

Things began to change five years ago when a patient’s story and a resident’s question led Sunil J. Patel, M.D., chair of the Department of Neurosurgery, to re-examine his assumptions about the pineal gland. A patient presented with imaging evidence of a pineal cyst and a set of neurological symptoms that caused her to leave a very successful career and become virtually house-bound, unable to care for her children. Her symptoms were not consistent with a pineal tumor, and no other neurologic or metabolic cause for them could be found.

That’s when a resident asked if the pineal cyst could be causing the patient’s problems. And for the first time, Patel opted to excise the cyst. The results shocked him. When the patient came in for a follow-up visit several weeks later, her symptoms had vanished. What’s more, the pathology report revealed that the excised mass was not a cyst at all but rather a benign tumor known as a pineocytoma.

Patel has since identified a constellation of symptoms — headaches, insomnia, episodic cognitive deficits and, rarely, numbness in limbs and problems with balance — that are associated with pineocytomas. He is one of only a handful of surgeons in the world who resects pineal cysts and has now performed more than 40 of these surgeries. In most cases, the pineal cyst has turned out to be, as expected, a pineocytoma. Ninety percent of these patients have achieved complete symptom resolution, and all achieve at least partial resolution.

It’s worth taking a second look.