| Popis: |
Background: In the neurological and neurosurgical follow up of our patients with pineal region expansions, we have noticed certain clinical and neurophysiological regularities. Objective: To perform retrospective study including 84 patients with pineal region expansions in the period from 1992 to 2009. Patients and methods: The study included 55 women and 29 men. All patients had headache, while 32 patients (38%) had primary generalized seizures. Common EEG pattern showed paroxysmal discharges of 3 or more Hz spike-and-wave complexes. Brain MRI showed in 70 patients (83.4%) cysts, and 14 patients (16.67%) had expansive process with compressive effect. Based on the size of the cyst (15 mm or more) and signs of compression on the quadrigeminal plate and of the surrounding veins operation was performed in 70 patients. Results: Pathohistological analysis revealed pineocytomas in 11 cases (15.71%), pinealoblastomas in 2 cases (2.86%), one case of teratoma (1.43%), while 56 patients had cysts (80%). Following surgery clinical condition improved in all patients-patients became seizure- free and headaches significantly decreased, and other symptoms (diplopiae, nausea, vomiting, vertigo and blurred vision) disappeared. Conclusion: Headache and also primary generalized seizures are often present in patients with pineal region expansions. Mass effect on the surrounding veins and compression on the quadrigeminal plate and the aqueduct, together with hemosiderin deposits can be involved in the pathogenesis of seizures. We suggest to perform high resolution brain MRI in all young patients that have seizures and specific EEG changes. |
