Abstract

Pineal cysts are frequently discovered by chance on magnetic resonance imaging (MRI) and are typically asymptomatic. However, hydrocephalus may develop and show symptoms when the cyst in the ventricles acts as an obstruction mechanism. We herein present a case involving a 52-year-old man with hydrocephalus due to the pineal cyst, who was effectively treated by an endoscope. He was transported by emergency with a chief complaint of impaired consciousness. At the time of admission, Glasgow coma Scale E4V4M6 was found, hydrocephalus with an Evans Index of about 0.3 was observed on the head computed tomography (CT), and a cystic lesion was observed on the pineal gland on the MRI During surgery, we tore the pineal cyst’s wall using forceps since it was blocking the aqueduct. Furthermore, an endoscopic third ventriculostomy was added in preparation for the recurrence of postoperative cerebral aqueduct obstruction. His awareness returned after the procedure, and he was released with no neurological damage. We believe that neuro endoscopic surgery is becoming the first choice for symptomatic pineal cysts because it is minimally invasive and safe.

Keywords

pineal cyst, hydrocephalus, endoscopic third ventriculostomy, aqueduct obstruction