For generations, neurosurgeons have been taught to discount imaging evidence of a pineal cyst as inconsequential, in part because resection of the gland in cases of pineal tumor has led to no functional loss. However, that has left little clinical recourse to patients with pineal cysts experiencing symptoms such as headaches, double visions or nausea for which there is no other neurological explanation. Sunil J. Patel, M.D., chair of the Department of Neurosurgery at the Medical University of South Carolina, is one of a handful of surgeons in the world who resects symptomatic pineal cysts. He has now performed more than 40 of these surgeries, and in most cases they have turned out to be pineocytomas. Ninety percent of these patients have achieved complete symptom resolution, and all achieve at least partial resolution. In this video, Dr. Patel discusses his experience with these patients and how he decides when surgery is appropriate.