Introduction. Symptomatic pineal cysts are rare, and their optimal management remains controversial and not clearly defined. Case Report. We present a case of a 45-year-old female who presented with several weeks of headache and acute-onset vertigo beginning the night prior to admission. Her medical history included an asymptomatic pineal cyst incidentally identified on magnetic resonance imaging two years earlier. Current imaging demonstrated marked enlargement of the pineal cyst with compression of the Sylvian aqueduct, resulting in obstructive hydrocephalus. The patient underwent a single-session combined endoscopic procedure with neuronavigation guidance. An endoscopic third ventriculostomy was first performed via a right frontal burr hole (Kocher?s point) to restore cerebrospinal fluid circulation. Through a second frontal burr hole, the pineal cyst wall was fenestrated and a biopsy was obtained. Both procedures were performed with the patient in the supine position and neutral head alignment. No intraoperative or postoperative complications were observed. Postoperative computed tomography confirmed ventriculostomy patency and reduction in ventricular size. At three-month follow-up, the patient remained asymptomatic. Conclusion. A combined minimally invasive endoscopic approach can effectively addressed both obstructive hydrocephalus and symptomatic pineal cyst in a single surgical session.
Tesic et al. (Wed,) studied this question.