Pineal cysts are a frequent finding on autopsy, while their clinical manifestation is exceptional. In 1994-1998 seven patients were treated with the diagnosis of a cyst in the pineal region. All were women aged 10-50 years, mean 28.4 years with symptoms of intracranial hypertension, headache and epileptic fits. In three of seven patients there were impaired conjugated movements of the eyes. All patients were operated: in a sitting position by a supracerebellar infratentorial approach, fenestration of the cyst was performed, collection of histological material and resection of the bursa. The 30-day mortality/morbidity was 0%. In the oldest patient after 6 months a facial paresis was found, slight right-sided hemiparesis and nystagmus. MR revealed an arachnoidal cyst above the right cerebellar hemisphere, the condition improved after resection of the cyst. The authors discuss the benefits and risks of different possible conservative and surgical solutions of symptomatic pineal cysts.

        Key words: pinealis, cyst, surgery, hydrocephalus