{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:56:00Z","timestamp":1777312560564,"version":"3.51.4"},"reference-count":50,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>Background: The central nervous system is an unusual location of sarcoidosis, which commonly affects the cranial nerves, meninges, hypothalamus, and pituitary gland. Involvement of the pineal region is extremely rare. This systematic review focused on the diagnosis and management of pineal region sarcoidosis, dorsal mesencephalon, and periaqueductal region.<\/jats:p>\n                  <jats:p>Objectives: This study aimed to discuss diagnostic modalities and best management tools of the aforementioned pathology.<\/jats:p>\n                  <jats:p>Methods: ScienceDirect, PubMed, and Google Scholar databases were searched for English or French articles about sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region. The clinical case of a patient managed at our department that we believe is directly relevant to this review is also presented. Patients\u2019 demographics, clinical presentations, presence of hydrocephalus, other sarcoidosis locations in the central nervous system, and medical treatment were collected. Surgical management, surgical approach, and outcomes and complications of each procedure were also obtained. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.<\/jats:p>\n                  <jats:p>Results: Fifteen cases were examined. The study sample consisted of nine (60%) male and six (40%) female, and the mean age was 32 years. Eight (53%) patients had hydrocephalus, and the predominant clinical presentations were signs of increasing intracranial pressure (headaches, vomiting, and papilledema). Six (40%) patients had diplopia, and convergence\u2013retraction nystagmus was noted in three (20%) patients. Argyll Robertson sign was present in one patient and suspected in another patient (13%). Medical treatment consisted mainly of steroids (93% of cases). Open surgery on the pineal region was performed in five patients, and four of them reported to have serious complications (such as ophthalmoplegia, hemianopsia, hemiparesis, bilateral third cranial nerve paresis, and cerebellar syndrome). Endoscopic management was performed in two patients without complications.<\/jats:p>\n                  <jats:p>Conclusion: To treat hydrocephalus, brain imaging is mandatory in patients with sarcoidosis if intracranial hypertension is suspected. In pineal region sarcoidosis, management of hydrocephalus is the priority, followed by medical treatment of the lesion. Open surgery of any approach presents a high risk of complications; thus, an endoscopic approach is the preferred management, as it treats hydrocephalus and makes biopsy possible with minimal risk.<\/jats:p>","DOI":"10.5339\/qmj.2021.29","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T04:31:11Z","timestamp":1629779471000},"source":"Crossref","is-referenced-by-count":1,"title":["Sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region: Case report and systematic review"],"prefix":"10.5339","volume":"2021","author":[{"given":"Adel","family":"Khelifa","sequence":"first","affiliation":[{"name":"Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail: drkhelifaadel@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid","family":"Bennabi","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail: drkhelifaadel@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fay\u00e7al","family":"Aichaoui","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail: drkhelifaadel@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salim","family":"Meziani","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail: drkhelifaadel@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelhalim","family":"Morsli","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail: drkhelifaadel@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"248:","key":"CIT0001","series-title":"J Neurol","first-page":"363\u2013372","article-title":"Neurosarcoidosis a review of its intracranial manifestation","author":"Nowak\n \nDA\n,","year":"2001"},{"issue":"9:","key":"CIT0002","series-title":"Curr Neuropharmacol","first-page":"429\u2013436","article-title":"Neurosarcoidosis","author":"Lacomis\n \nD","year":"2011"},{"issue":"62:","key":"CIT0003","series-title":"J Clin Epidemiol","first-page":"1006\u20131012","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","author":"Moher\n \nD\n,","year":"2009"},{"issue":"47:","key":"CIT0004","series-title":"J Neurosurg","first-page":"630\u2013632","article-title":"Sarcoidosis of the pineal gland case report","author":"Schaefer\n \nM\n,","year":"1977"},{"issue":"4:","key":"CIT0005","series-title":"Rev Med Interne","first-page":"357\u2013359","article-title":"Sarco\u00efdose diss\u00e9min\u00e9e avec une complication neurologique rare la st\u00e9nose de l\u2018aqueduc de Sylvius","author":"Giroud\n \nM\n,","year":"1983"},{"issue":"289:","key":"CIT0006","series-title":"Br Med J","first-page":"259","article-title":"Argyll Robertson pupils due to neurosarcoidosis evidence for site of lesion","author":"Poole\n \nCJM","year":"1984"},{"issue":"9:","key":"CIT0007","series-title":"J Comput Assist Tomogr","first-page":"381\u2013383","article-title":"A unique case of neurosarcoidosis with pineal and suprasellar involvement CT and pathological demonstration","author":"Wall\n \nMJ\n,","year":"1985"},{"issue":"11:","key":"CIT0008","series-title":"AJNR Am J Neuroradiol","first-page":"915\u2013923","article-title":"Sarcoidosis of the CNS comparison of unenhanced and enhanced MR Images","author":"Sherman\n \nJL\n,","year":"1990"},{"issue":"13:","key":"CIT0009","series-title":"J Comput Assist Tomogr","first-page":"110\u2013112","article-title":"Sarcoidosis of the pineal region CT and MR studies","author":"Martin\n \nN\n,","year":"1989"},{"issue":"6:","key":"CIT0010","series-title":"J Clin Neurosci","first-page":"259\u2013261","article-title":"Neurosarcoidosis presenting as an isolated mass of the quadrigeminal plate","author":"Sattelmeyer\n \nV M\n,","year":"1999"},{"issue":"221:","key":"CIT0011","series-title":"Klin Monabl Augenheilkd","first-page":"404\u2013407","article-title":"Selective and sequential therapy of oculomotor and palpebral sequelae resulting from biopsy of dorsal midbrain sarcoidosis","author":"Klainguti\n \nG\n,","year":"2004"},{"issue":"52:","key":"CIT0012","series-title":"Jpn J Ophthalmol","first-page":"236\u2013238","article-title":"Dorsal midbrain syndrome induced by midbrain neurosarcoidosis","author":"Oishi\n \nA\n,","year":"2008"},{"issue":"69:","key":"CIT0013","series-title":"Surg Neurol","first-page":"288\u2013292","article-title":"Obstructive hydrocephalus and progressive psychosis rare presentations of neurosarcoidosis","author":"Westhout\n \nFD\n,","year":"2008"},{"issue":"91:","key":"CIT0014","series-title":"J Neurooncol","first-page":"113\u2013116","article-title":"Sarcoidosis of the pineal gland an unusual presentation of neurosarcoidosis","author":"Yang\n \nI\n,","year":"2009"},{"issue":"128:","key":"CIT0015","series-title":"N Z Med J","first-page":"110\u2013113","article-title":"Sarcoidosis presenting with acute hydrocephalus in a New Zealand European female","author":"Chandna\n \nA\n,","year":"2015"},{"issue":"58:","key":"CIT0016","series-title":"Intern Med","first-page":"105\u2013108","article-title":"Neurosarcoidosis presenting with obstructive hydrocephalus successfully treated with endoscopic third ventriculostomy","author":"Nakayasu\n \nH\n,","year":"2019"},{"issue":"3:","key":"CIT0017","series-title":"J Endocr Soc","first-page":"SUN-427","article-title":"SUN-427 Hypopituitarism as a rare manifestation in a patient with neurosarcoidosis","author":"O'Connor\n \nA\n,","year":"2019"},{"issue":"8:","key":"CIT0018","series-title":"Clin Case Rep","first-page":"363\u2013368","article-title":"Hydrocephalus as the presenting symptom of sarcoidosis a case report and review of 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Hydrocephalus a rare manifestation of sarcoidosis","author":"Rooijen\n \nJMV\n,","year":"2011"},{"issue":"26:","key":"CIT0023","series-title":"Surg Neurol","first-page":"67\u201371","article-title":"Neurosarcoidosis causing ventricular loculation hydrocephalus, and death","author":"Schlitt\n \nM\n,","year":"1986"},{"issue":"92:","key":"CIT0024","series-title":"QJM","first-page":"103\u2013117","article-title":"Central nervous system sarcoidosis diagnosis and management","author":"Zajicek\n \nJP\n,","year":"1999"},{"issue":"49:","key":"CIT0025","series-title":"J Neurosurg Sci","first-page":"97\u2013106","article-title":"Neuroendoscopic management of hydrocephalus secondary to midline and pineal lesions","author":"Cipri\n \nS\n,","year":"2005"},{"issue":"248:","key":"CIT0001","series-title":"J Neurol","first-page":"363\u2013372","article-title":"Neurosarcoidosis a review of its intracranial manifestation","author":"Nowak\n \nDA\n,","year":"2001"},{"issue":"9:","key":"CIT0002","series-title":"Curr Neuropharmacol","first-page":"429\u2013436","article-title":"Neurosarcoidosis","author":"Lacomis\n \nD","year":"2011"},{"issue":"62:","key":"CIT0003","series-title":"J Clin Epidemiol","first-page":"1006\u20131012","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","author":"Moher\n \nD\n,","year":"2009"},{"issue":"47:","key":"CIT0004","series-title":"J Neurosurg","first-page":"630\u2013632","article-title":"Sarcoidosis of the pineal gland case report","author":"Schaefer\n \nM\n,","year":"1977"},{"issue":"4:","key":"CIT0005","series-title":"Rev Med Interne","first-page":"357\u2013359","article-title":"Sarco\u00efdose diss\u00e9min\u00e9e avec une complication neurologique rare la st\u00e9nose de l\u2018aqueduc de Sylvius","author":"Giroud\n \nM\n,","year":"1983"},{"issue":"289:","key":"CIT0006","series-title":"Br Med J","first-page":"259","article-title":"Argyll Robertson pupils due to neurosarcoidosis evidence for site of lesion","author":"Poole\n \nCJM","year":"1984"},{"issue":"9:","key":"CIT0007","series-title":"J Comput Assist Tomogr","first-page":"381\u2013383","article-title":"A unique case of neurosarcoidosis with pineal and suprasellar involvement CT and pathological demonstration","author":"Wall\n \nMJ\n,","year":"1985"},{"issue":"11:","key":"CIT0008","series-title":"AJNR Am J Neuroradiol","first-page":"915\u2013923","article-title":"Sarcoidosis of the CNS comparison of unenhanced and enhanced MR Images","author":"Sherman\n \nJL\n,","year":"1990"},{"issue":"13:","key":"CIT0009","series-title":"J Comput Assist Tomogr","first-page":"110\u2013112","article-title":"Sarcoidosis of the pineal region CT and MR studies","author":"Martin\n \nN\n,","year":"1989"},{"issue":"6:","key":"CIT0010","series-title":"J Clin Neurosci","first-page":"259\u2013261","article-title":"Neurosarcoidosis presenting as 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of neurosarcoidosis","author":"Yang\n \nI\n,","year":"2009"},{"issue":"128:","key":"CIT0015","series-title":"N Z Med J","first-page":"110\u2013113","article-title":"Sarcoidosis presenting with acute hydrocephalus in a New Zealand European female","author":"Chandna\n \nA\n,","year":"2015"},{"issue":"58:","key":"CIT0016","series-title":"Intern Med","first-page":"105\u2013108","article-title":"Neurosarcoidosis presenting with obstructive hydrocephalus successfully treated with endoscopic third ventriculostomy","author":"Nakayasu\n \nH\n,","year":"2019"},{"issue":"3:","key":"CIT0017","series-title":"J Endocr Soc","first-page":"SUN-427","article-title":"SUN-427 Hypopituitarism as a rare manifestation in a patient with neurosarcoidosis","author":"O'Connor\n \nA\n,","year":"2019"},{"issue":"8:","key":"CIT0018","series-title":"Clin Case Rep","first-page":"363\u2013368","article-title":"Hydrocephalus as the presenting symptom of sarcoidosis a case report and review of 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Hydrocephalus a rare manifestation of sarcoidosis","author":"Rooijen\n \nJMV\n,","year":"2011"},{"issue":"26:","key":"CIT0023","series-title":"Surg Neurol","first-page":"67\u201371","article-title":"Neurosarcoidosis causing ventricular loculation hydrocephalus, and death","author":"Schlitt\n \nM\n,","year":"1986"},{"issue":"92:","key":"CIT0024","series-title":"QJM","first-page":"103\u2013117","article-title":"Central nervous system sarcoidosis diagnosis and management","author":"Zajicek\n \nJP\n,","year":"1999"},{"issue":"49:","key":"CIT0025","series-title":"J Neurosurg Sci","first-page":"97\u2013106","article-title":"Neuroendoscopic management of hydrocephalus secondary to midline and pineal lesions","author":"Cipri\n \nS\n,","year":"2005"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2021\/2\/article-29.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2021\/2\/article-29.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2021\/2\/article-29.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:21:16Z","timestamp":1777310476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2021\/2\/article-29.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":50,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2021.29","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]}}}