Аннотация:Background: Pineal cysts (PCs) are benign lesions commonly found on intracranial imaging. Despite their highprevalence, there is no clear consensus on the most appropriate management of patients with PCs, especiallythose with symptomatic nonhydrocephalic cysts.Methods: A retrospective analysis was performed on 142 patients with PCs (103 surgical cases and 39conservatively managed cases). Data were examined, including clinical presentation, imaging findings,ophthalmological status, natural course, postoperative outcomes, and complications.Results: Surgical group: the most common symptom was headache (92%), followed by signs of intracranialhypertension due to hydrocephalus (22%). New radiological feature of PCs was found in 11 patients. From71 patients with long-term follow-up, headache completely resolved in 44 (62%) patients; marked improvementwas observed in 20 (29%); in 7 (9%) – headache remained unchanged. The most common postoperativecomplication was neuro-ophthalmological disorders (23%), with a tendency for resolution in the long-termfollow-up period. Neuro-ophthalmological symptoms at last follow-up included upward gaze palsy (6%) andskew deviation (5%), followed by convergence disorders (3%) and eyelid-retraction (2%). Natural course group:PC size remained stable in 34 (87%) patients during the follow-up period. The patient’s gender or age was not asignificant predictor of cyst growth (P = 0.4, P = 0.56).Conclusion: The majority of patients with a newly diagnosed PC remain clinically and radiologically stable.Patients with nonhydrocephalic PCs and intractable headaches experience significant relief in headachesymptoms, but are at risk of mild to moderate neuro-ophthalmological disorders. The natural course of PCs andfactors promoting their growth still remains poorly defined.