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In view of the limited data for pineal cyst resection in the absence of hydrocephalus, and the potential risk of this approach, we have analyzed our patient cohort focusing on strategies to avoid complications according to our experience in a series of 73 pineal cyst patients. From 2003 to 2015, we reviewed our database retrospectively for all patients operated on a pineal cyst. Furthermore, we prospectively collected patients from 2016 to 2020. In summary, 73 patients with a pineal cyst were treated surgically between 2003 and 2020. All patients were operated on via a microscopic supracerebellar-infratentorial (SCIT) approach. The mean follow-up period was 26.6\u00a0months (range: 6\u2013139\u00a0months). Seventy-three patients underwent surgery for a pineal cyst. An absence of enlarged ventricles was documented in 62 patients (51 female, 11 male, mean age 28.1 (range 4\u201359) years). Main presenting symptoms included headache, visual disturbances, dizziness\/vertigo, nausea\/emesis, and sleep disturbances. Complete cyst resection was achieved in 59\/62 patients. Fifty-five of 62 (89%) patients improved after surgery with good or even excellent results according to the Chicago Chiari Outcome Scale, with complete or partial resolution of the leading symptoms. Pineal cysts resection might be an indication in certain patients for surgery even in the absence of ventriculomegaly. The high percentage of postoperative resolution of quality-of-life impairing symptoms in our series seems to justify surgery. Preoperatively, other causes of the leading symptoms have to be excluded.<\/jats:p>","DOI":"10.1007\/s10143-022-01831-2","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T15:04:09Z","timestamp":1657724649000},"page":"3327-3337","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach\u2014surgical strategies, complications, and their avoidance"],"prefix":"10.1007","volume":"45","author":[{"given":"Steffen","family":"Fleck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed El","family":"Damaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Matthes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab El","family":"Rafaee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Marx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Baldauf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry W. 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All patients gave written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors transfer to Springer (respective to owner if other than Springer and for US government employees: to the extent transferable) the non-exclusive publication rights and he warrants that his\/her contribution is original and that he\/she has full power to make this grant. The author signs for and accepts responsibility for releasing this material on behalf of any and all co-authors. This transfer of publication rights covers the non-exclusive right to reproduce and distribute the article, including reprints, translations, photographic reproductions, microform, electronic form (offline, online), or any other reproductions of similar nature.The author may self-archive an author-created version of his article on his own website and his institution\u2019s repository, including his final version; however, he may not use Springer\u2019s PDF version which is posted on . Furthermore, the author may only post his version provided acknowledgement is given to the Journal and Springer as one of the original places of publication and a link is inserted to the published article on Springer\u2019s website.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}