Surgery for pineal cysts with symptoms in the absence of hydrocephalus: a prospective cohort study.

BACKGROUND

There is mounting evidence for surgery as an effective treatment in selected patients with non-hydrocephalic symptomatic pineal cyst (nhSPC) syndrome. We present the first prospective cohort study of surgical PC resection to treat nhSPC syndrome.

METHODS

CamProS-PC is an observational, single-centre, prospective cohort study. Patients were eligible if aged >18 years, PC size >10 mm, had severe symptoms refractory to medical treatment, without ventriculomegaly. Patient-reported data were collected preoperatively, and 3 and 12 months postoperatively. MR imaging was performed before and 12 months after surgery. The primary outcome was improvement in Role Functioning (RF) at 12 months. Secondary outcomes were changes in other domains of Health-Related Quality of Life (HRQoL) and symptoms at 3 and 12 months, and safety of the intervention. CamProS-PC is registered (ISRCTN51545574) and has been completed.

FINDINGS: Between January 2019 and May 2023, 122 consecutive patients were screened and 40 were recruited and underwent PC resection. No loss of follow-up occurred. Mean age was 38 [SD 28-49] with 80% (32/40) females. At baseline, all patients reported headaches, 95% (38/40) dizziness, and 98% (39/40) reported impairment of vision, 98% (38/40) sleep, 90% (36/40) concentration, 88% (35/40) memory, 68% (27/40) speech, and 60% (24/40) hearing. At 12 months postoperatively, HRQoL was improved across all functional scales: RF mean difference 46 [SD 11-80, p < 0.0001] points, Physical 22 [SD -1 to 45, p < 0.0001], Emotional 35 [SD -2 to 71, p < 0.0001], Cognitive 38 [SD 3-73, p < 0.0001], and Social 50 [SD 14-87, p < 0.0001]. Global Health Status improved by 32 [SD 4-61, p < 0.0001] points. Symptoms improved overall in 95% (38/40) of patients. Most benefits were already seen at 3 months. Complications occurred in 23% (9/40) of patients; one was permanent (diplopia). All patients were alive at last follow-up.

INTERPRETATION: CamProS-PC demonstrated significant benefit to HRQoL and symptoms one year after PC resection with overall acceptable safety profile.

FUNDING: Department of Clinical Neuroscience, University of Cambridge.