Open Access

Xenia Hautmann, Fares Komboz, Silvia Hernández-Durán, Tammam Abboud, Dorothee Mielke, Veit Rohde

• Background: Melatonin (ML) is synthesized in the pineal gland and is subject to a circadian rhythm. Patients with symptomatic pineal cysts (PC) - who do not have hydrocephalus - suffer from a variety of symptoms in addition to cephalgias and sleep disorders. However, the pathomechanism is still unclear - a disturbed ML secretion is being discussed. However, the data regarding melatonin levels in patients with PC is still insufficient. Methods: As part of a prospective study in patients with symptomatic PC, we examined the preoperative ML level in the saliva in a half-hour rhythm between 08:30 p.m. and 01:00 a.m.. In addition, symptoms, in particular sleep quality and pain, were recorded over a week with the help of a diary. We analyzed the relationship between symptoms and the ML level using Spearman's correlation and the deviation of the melatonin level from the normal values using a Wilcoxon test. Results: A total of eight female patients have been included so far. The average ageBackground: Melatonin (ML) is synthesized in the pineal gland and is subject to a circadian rhythm. Patients with symptomatic pineal cysts (PC) - who do not have hydrocephalus - suffer from a variety of symptoms in addition to cephalgias and sleep disorders. However, the pathomechanism is still unclear - a disturbed ML secretion is being discussed. However, the data regarding melatonin levels in patients with PC is still insufficient. Methods: As part of a prospective study in patients with symptomatic PC, we examined the preoperative ML level in the saliva in a half-hour rhythm between 08:30 p.m. and 01:00 a.m.. In addition, symptoms, in particular sleep quality and pain, were recorded over a week with the help of a diary. We analyzed the relationship between symptoms and the ML level using Spearman's correlation and the deviation of the melatonin level from the normal values using a Wilcoxon test. Results: A total of eight female patients have been included so far. The average age was 36.3 years. The average size of the PC was 12.3 mm. The patients had been suffering from symptoms for an average of 3.2 years. They were able to sleep on 2.7 out of 7 days, problems falling asleep occurred on 3.6 out of 7 days. Headaches occurred on an average of 5.6 out of 7 days. Four of the 8 patients suffered from continuous headaches. The severity of the headaches was on average 3 to 7 on the VAS. 50% of the patients (n=4) reported nausea. Visual disturbances and fatigue were only present in 25% (n=2) of the patients. There was no significant correlation between the size of the PC and the ML level. The ML level at 8:30 p.m. correlated significantly with problems sleeping through the night (p= 0.006). There was no significant correlation between ML level and the other symptoms recorded. However, the ML values deviated significantly from the reference values, particularly due to a lack of increase in ML concentration during the night. While three patients were still within the normal range at 8:30 p.m., from 10:00 p.m. only one was, and from 00:30 a.m. all patients were below the normal range. The deviation from the reference values was statistically significant for the measurements at 8:30 p.m. (p=0.0469), 09:30 p.m. (p= 0.0078), 10:00 p.m. (p=0.0078), 10:30 p.m. (p= 0.0156), 00:30 a.m. (p= 0.047) and 01:00 a.m. (p= 0.047). Conclusions: The ML level in patients with symptomatic PC deviates significantly from normal ML levels. In particular, a lack of increase at night can be observed, which may provide an explanation for the symptoms. The lack of correlation with symptoms in our group can be attributed to the fact that no symptom-free comparison group was analyzed.…