Pineal region lesions is an umbrella term that includes germ cell tumors, pineocytomas, pineal gliomas, pineoblastomas, cysts, and vascular lesions [1]. Of these, pineal cysts are the most common, incidentally identified in 20–41% of autopsies [2], [3], [4]. Pineal region tumors comprise 3–8% of brain tumors in children and 0.4–1% of tumors in adults [1], [5], [6]. Due to the close proximity of structures within this region, even small lesions can create mass effect, resulting in a myriad of neurological symptoms from seizure activity to cerebellar, corticospinal, sensory, and hormonal disturbances [1], [2], [5], [7], [8], [9], [10], [11], [12].

Many of these symptoms are associated with hydrocephalus or other signs of raised intercranial pressure, and thought to arise from obstruction of the Sylvian aqueduct which often correlates with tectal plate compression [1], [5], [7]. Alterations in cerebral spinal fluid (CSF) dynamics such as those seen in obstructive hydrocephalus have been associated with changes in patient autonomic nervous system function and are thought to contribute to symptoms in patients with pineal lesions [8], [13]. Additionally, the superior colliculus, a structure often impacted by pineal region lesions, has been demonstrated to influence autonomic responses [14]. Autonomic dysfunction is loosely defined as a dysregulation of at least one component of the autonomic nervous system such as blood pressure modulation, thermal regulation, or pupillary response [15]. In patients with pineal regions lesions, symptoms that could be attributed to autonomic dysfunction include dizziness, pupillary dysfunction, photophobia, fatigue and alterations in presentation with orthostasis have been identified.

Current literature regarding pineal region lesions focuses on their clinical presentation, potential global impact, and treatment, but no studies have looked at the relationship between tectal plate compression and the autonomic nervous system. This systematic review examines the current literature on pineal region lesions causing tectal plate compression with a specific interest in clinical presentation that could be autonomic dysfunction in nature.