PMC9282732_01
MRI of the brain on admission showing the cyst isointense to cerebrospinal fluid (blue arrow) in T1, T2, and flair, dilated ventricles (orange arrow), and compressed cerebral aqueduct (white arrow).
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F1
A brain MRI with contrast enhancement showed an irregular noncontract enhancing cystic lesion of the pineal region [Figure 1].
Intraoperative photo from a microscope with at x10: the hyperemic cerebellar hemispheres are visualized (black arrow), tentorium superiorly, the deep veins (blue arrow); a yellowish lesion is visible intimately adjacent to the quadrigeminal plate (green arrow).
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F2
These adhesions were carefully released and the whitish-yellow cyst was visualized [Figure 2].
Day 1 postoperative CT showing reduced cyst size and pneumocephalus (white arrow) and restored cerebral aqueduct patency (blue arrow).
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F3
Postoperative computed tomography (CT) showed decreased cyst size with hyperdense content (interpreted as normal postoperative changes), mild pneumocephalus, and a patent cerebral aqueduct [Figure 3].
Photo from a microscope. Epithelial lining shows partly pseudostratified ciliated and partly - cuboidal cells. Electrocoagulation damage to the tissue is noted. The epithelium was EMA positive. Positive reaction of epithelium with anti-pankeratin (AE1/AE3) was demonstrated.
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F4
Epithelial cells expressed cytokeratin (CK) 7, pan-keratin, and epithelial membrane antigen and were negative for glial fibrillary acidic protein, S100, and CK 20 [Figure 4].
Day 6 postoperative MRI showing reduction in cyst size (blue arrow) and positive flow of CSF through the aqueduct (white arrow).
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F5
Day 10 CT scan showing features of hydrocephalus, that is, ventricular enlargement, compression of the basal cisterns, and convexity subarachnoid spaces (blue arrow). Compared to previous images, the cyst is obviously enlarged (white arrow) with compression of the cerebral aqueduct (green arrow).
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F6
CSF leak. Control brain CT showed features of noncommunicating hydrocephalus and a x 2.5 increase in the cyst size compressing the cerebral aqueduct [Figure 6].
MRI 1 year after surgery showed cystic lesions in the operative corridor (blue arrow) and an enlarging pineal region cyst with its contents slightly more hyperintense to CSF on T1 (white arrow).
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F7
Postoperative MRI showed regression of the hydrocephalus and increase of the endodermal cyst to about 80% of the original size [Figure 7]. The patient was managed conservatively with a follow-up MRI done after 1 year and 20 months [Figures 7 and 9].
MRI of the brain, 11th day after surgery.
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F8
However, 1-year routine control MRI showed significant changes compared to previous images [Figure 8].
MRI at 20-month postoperative showing increased number of cysts (blue arrow) and progressive increase in pineal cyst size (white arrow).
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F9
The patient was managed conservatively with a follow-up MRI done after 1 year and 20 months [Figures 7 and 9].