Possible Pineal Cyst Surgery

  I was diagonosed with a 13 mm pineal cyst and a Chiari-1 Deformation of the brain 2 years ago. After having 4 MRI's and seeing 2 different Neurologists I was finally sent to have a 5th MRI and then sent to a Neuro Surgeon today. The cyst had grown from 13 mm to 16 mm in 7 months. The Neuro Surgeon expalined in great detail how the surgery would be performed and we discussed that I wait and have another MRI done in 3 months. I am concerned from reading other e-mails on this website that this may not be the best decision. Do you suggest that I go ahead with the surgery or wait for 3 months.

[Vanessa Lacuesta]

Hi

Are you symptomatic?

As of late, have you been presenting with visual symptoms or headaches?

Any weakness, dizziness, nausea and vomiting?

Pineal cysts when asymptomatic may be monitored radiographically.  Any progression in size and presence of symptoms are indications for surgery. For the past two years , the cyst has grown 3 mm in diameter? In those two years have you ever had any of the symptoms I mentioned above?

[sarahsenior09]

Ive had a pineal cyst for about 2 years, am symptomatic, but no one has wanted to take mine out.. it has grown but if it is not malignant, why let them perform unnessicary brain surgery????

[savanny]

my son was jude dx with a 1cm pineal cyst and also lymes is there a link dose anyone know

[Markrubin]

Hi ,

I just found out last night I have a pineal cysts 12mm by 15 mm. I have no insurance and would have to pay for any myself. I'm find difficulties in concintration and headack with vision problems. Does anyone have any solutions or ideas as to what I should do.

Please help me,

Mark

[ycompanys]

Neurologists may be very quick to tell you that you are fine with a pineal cyst and that it is not causing your symptoms.  But beware:  1) Doctors in general don't really undestand what the pineal gland does; and 2) Some don't seem to understand the difference between symptomatic and asymptomatic pineal glands and tell their patients not to worry about pineal cysts.

Some things to keep in mind, according to the medical literature:

1) The most common symptom is headaches, followed by vision problems and dizziness, and in some cases insomnia, nausea and cognitive deficits, particularly if cognitive deficits are involved.  
2) Pineal cysts can be symptomatic if they are larger than 0.5 cm.  Problems occur when the cysts cause compression in the brain, or when they are associated with apoplexy or hydrocephalus.
3) Radiologists cannot easily distinguish between cysts and benign tumors, often leading to misdiagnosis.  NOTE:  A benign tumor is not metastatic, not malignant.  
4) If you are in the 18-34 age group, your cyst can grow, so you should get MRIs every 3-6 months.  If your doctor does not want to, get a new doctor.
5) If you have to get surgery, get the following one but only if you have compression or hydrocephalus and your symptoms are incapacitating:  Suboccipital craniotomt with infratentorial-supracerebellar approach and microsurgical resection of pineal cyst.  Contrary to what is stated above, this is NOT brain surgery.  They access your pineal region from beneath the brain, so they do not affect your brain at all.  It sounds like a scary procedure but is actually straightforward for a good brain neurosurgeon.  The surgeon essentially inserts a microscopic endoscope that magnifies the area by 50x and uses a navigation system to get him there.  It is minimally invasive.  The medical literature says that most patients whose pineal cysts are not too large (e.g., < 4.5 cm) become completely asymptomatic after surgery.  The surgery entails a 6-8 week recovery, and a small incision in the head and removal of skull bone, which grows back after surgery.

The most important thing is to get a doctor who takes your pineal cyst seriously.  It is a rare disorder, and few doctors understand it well.  So you will need to be persistent.

[pmpmama4]

I need a good doctor in phoenix

[selmaS]

Hi...this thread talks about 2 different issues which do u have or do u have both?

There is a chiari forum here on MedHelp....that may be able to offer support and help with drs names to help u research....I hope u stop by....

http://www.medhelp.org/forums/Chiari-Malformation/show/257?camp=msc

"selma"

[buffbarb]

I had the surgery five weeks ago - no more cyst. no more symptoms. Go figure.

I started having headaches, daily and neck/ear/jaw pain back in May 2010 - sudden onset. . Went to an ENT, a dentist, a TMJ specialist, back to PCP. In June started getting migraines - about 1-2x a week lasting for hours.
They did MRI in July and found a pineal cyst 1.2x 1.7x1.0. More tests, more meds, doctors telling me I've always had headaches, they were sinus headaches, that the cyst wasn't causing the headaches. Migraines were coming 3-4 times a week - lasting 6 hours or more, I was taking way lots of drugs and not functioning well.

Saw a surgeon at Barrows Neurosurgical in Phoenix (where I live) and she said we should rule out all other possibilities, try different meds. Of course good advice- no one wants a craniotomy right?
My MRI showed no hydrocephalus but mild mass effect on the tectum.

Went back to the ENT, saw endocrinologist, opthalmologist, two neurologists and tried 8 meds. Kept getting worse. September had more MRIs , they showed no growth- so we decided to wait and do another set of MRIs after Christmas and see if we could find meds to control the pain. Was having migrines almost every single day at this point.Also neck, jaw, ear and facial pain, some motion sickness too.

Was taking a ton of pain meds and topomax (topamax) and imitrex every other day , sinus meds- you name it I took it and nothing was controlling it. Woke with a headache every day, was with me all day, went migraine at night. Was horrible and I'm no wuss when it comes to pain believe me.

I ended up in the ER Oct 18th with a migraine we couldn't stop. I literally cried for hours, two doses of IV meds, stayed in bed a week. Saw the surgeon & she read everything & said all conservative measures failed, she'd do the surgery. So on October 25th I had brain surgery. Posterior fossa craniotomy - so they went in from the back of my skull (which is why I still have my hair) , endoscopic tube up there and pulled out the cyst . And now five weeks later I have no more headaches, migraines, jaw/ear pain. All done. I do have alot of fatigue, some nerve pain which they tell me will go away (sharp stabby pains on the side of my head above and to the side of the incision) but totally worth it. I couldn't function with the headache- was in bed in the dark most nights, couldn't play with my kids, was pretty horrible. But I'm good now.

Was a scary month but have lots to be Thankful for. Great surgeon, great health insurance, supportive friends, family and church. Made it through and can now enjoy Christmas without daily pain. I'm on NO MEDS at all now except my thyroid meds and some melatonin for sleep (pineal gland controls circadian rhythms and sleep/wake cycles and still having sleep issues) and still some neck pain they think probably from scrunching up due to the headaches.

DO not give up. Read on pubmed.com and other published medical journals. http://www.ncbi.nlm.nih.gov/pubmed/18005138

Talk to surgeons. Rule out everything else it could possibly be and do not give up. I have complete resolution of symptoms other then the nerve pain which should dissipate with time.

Hope some of this helps
Barb

[zcmom]

Can you recommend a neurosurgeon in Colorado?  My 16 year old son has a pineal cyst (8.8 mm X 11mm).  His symptoms are debilitating.  He can't read due to severe vertigo/dizziness and passes out, daily.  We have been to a neurosugeon and neurologist, neither of which even address it.  Any advice is appreciated.

[zcmom]

Would you mind telling me who your surgeon is/was?  Congrats on your recovery and successfull surgery.