Physiological alterations of pineal recess crowding in symptomatic non-hydrocephalic pineal cysts

Abstract Pineal cysts are prevalent in the population. Due to more widespread use of magnetic resonance imaging, an increasing number symptomatic patients with non-hydrocephalic pineal referred neurologists and neurosurgeons. Currently, there is no generally accepted theoretical framework for linking symptoms a cyst. We have previously suggested that cyst-induced crowding recess may affect venous runoff from deep cerebral veins crossing However, evidence underpinning this hypothesis sparse. In present study, we asked whether without imaging signs hydrocephalus be accompanied alterations blood flow internal veins, cerebrospinal fluid Sylvian aqueduct fluid-mediated tracer clearance brain along extravascular pathways (referred as glymphatic function). This prospective, observational study included individuals who underwent standardized protocol (n = 25): Eleven were treated surgically craniotomy cyst extirpation 14 managed conservatively surgery. Our findings suggest brain-wide effects: (i) There was significant negative correlation between degree within change maximum velocity at cyst, positive net aqueduct; (ii) increased by significantly impaired enrichment cortex subcortical white matter, indicative effect cohort also reported markedly subjective sleep quality; (iii) apparent diffusion coefficient (suggestive interstitial water content) thalamus (iv) associated symptoms. Comparison surgical cases [in whom 10/11 (91%) marked clinical improvement follow-up] 1/14 (7%) showed differences pre-treatment well subarachnoid spaces. Taken together, interpret these observations support alter even cause impairment transport possible implications trophic factors such melatonin.