Highlights
- •Pulsatile ICP was increased in symptomatic individuals with a non-hydrocephalic PC.
- •Pulsatile ICP and tectum-splenium-cyst ratio correlated positively.
- •Tectum-splenium-cyst ratio and an index of thalamic edema correlated positively.
- •Venous obstruction in pineal recess may cause central venous hypertension syndrome.
Abstract
Background
In symptomatic individuals with non-hydrocephalic pineal cysts (PCs), it remains controversial
what causes the symptoms. Based on magnetic resonance imaging (MRI) biomarkers, we
proposed that PC-associated crowding of the pineal recess may cause central venous
hypertension. The aim of this study was to compare pulsatile and static ICP in patients
with PCs and chronic daily headache (CDH), and compare ICP data in PC patients with
the previously identified MRI biomarkers.
Methods
All patients assessed with over-night ICP monitoring for PCs or CDH who had been ruled
out for idiopathic intracranial hypertension without papilledema (IIHWOP) were retrieved
from the database. The symptoms as well as the pulsatile and static ICP scores were
compared between the PC and CDH patients, and ICP scores were compared with the MRI
biomarkers indicative of central venous hypertension.
Results
The pulsatile ICP was significantly increased in the symptomatic patients with non-hydrocephalic
PCs as compared to the CDH patients. Pulsatile ICP was significantly increased in
the individuals with PC-grades 3–4, who had MRI biomarkers indicative of central venous
hypertension. The tectum-splenium-cyst ratio correlated positively with pulsatile
ICP and an index of thalamic edema.
Conclusions
Pulsatile ICP is increased in symptomatic patients with PCs and imaging evidence of
central venous hypertension, supporting the hypothesis that PC-induced crowding of
the pineal recess and venous obstruction may cause a central venous hypertension syndrome.
Keywords
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References
- Prevalence and natural history of pineal cysts in adults.J. Neurosurg. 2011; 115: 1106-1114
- Prevalence of pineal cysts in children and young adults. Clinical article.J. Neurosurg. Pediatr. 2009; 4: 230-236
- The natural history of pineal cysts in children and young adults.J. Neurosurg. Pediatr. 2010; 5: 162-166
- High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging.AJNR Am. J. Neuroradiol. 2007; 28: 1706-1709
- Symptomatic pineal cysts: clinical manifestations and management.Acta Neurochir. 2002; 144 (discussion 242): 233-242
- Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature.J. Neurol. Neurosurg. Psychiatry. 1989; 52: 991-995
- Pineal cyst resection in the absence of ventriculomegaly or Parinaud's syndrome: clinical outcomes and implications for patient selection.J. Neurosurg. 2015; 123: 352-356
- Pineal cysts in childhood.Childs Nerv. Syst. 2003; 19: 750-755
- Pripp, AH, Ringstad, GA, magnetic resonance imaging biomarkers indicate a central venous hypertension syndrome in patients with symptomatic pineal cysts.J. Neurol. Sci. 2016; 363: 207-216
- The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing.J. Neurosurg. 2016; 1–11
- Apparent diffusion coefficient and beyond: what diffusion MR imaging can tell us about tissue structure.Radiology. 2013; 268: 318-322
- A new method for processing of continuous intracranial pressure signals.Med. Eng. Phys. 2006; 28: 579-587
- Pineal cysts in children.Insights Imaging. 2011; 2: 671-678
- Utility of CSF pressure monitoring to identify idiopathic intracranial hypertension without papilledema in patients with chronic daily headache.Cephalalgia. 2004; 24: 495-502
- Radiological interpretation 2020: toward quantitative image assessment.Med. Phys. 2007; 34: 4173-4179
- Outcome of surgery for idiopathic normal pressure hydrocephalus: role of preoperative static and pulsatile intracranial pressure.World Neurosurg. 2016; 86 (e1): 186-193
- Characteristics of intracranial pressure (ICP) waves and ICP in children with treatment-responsive hydrocephalus.Acta Neurochir. 2015; 157: 1003-1014
- Static and pulsatile intracranial pressure in idiopathic intracranial hypertension.Clin. Neurol. Neurosurg. 2011; 113: 123-128
- Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study.Acta Neurochir. 2015; 157: 1411-1423
- Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds.Neurol. Res. 2007; 29: 798-802
- Thrombosis of the cerebral veins and sinuses.N. Engl. J. Med. 2005; 352: 1791-1798
- Brain-wide pathway for waste clearance captured by contrast-enhanced MRI.J. Clin. Invest. 2013; 123: 1299-1309
Article info
Publication history
Published online: June 11, 2016
Accepted:
June 10,
2016
Received in revised form:
May 11,
2016
Received:
March 9,
2016
Footnotes
☆Funding/financial support: Dept. of Neurosurgery, Oslo University Hospital – Rikshospitalet.
Identification
Copyright
© 2016 Elsevier B.V. All rights reserved.
