Resident Cedars Sinai Los Angeles, California, United States
Introduction: Arachnoid cysts (AC) of the cerebellopontine angle (CPA) typically have a benign natural history, however, in rare circumstances, can cause severe, potentially irreversible neurologic maladies. To date, a paucity of data exists on the topic with the indications and efficacy of surgery limited to mostly expert opinion.
Methods: A systematic literature search was performed in May 2022 querying several scientific databases, per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgery types were performed.
Results: A total of 55 patients from the literature and 5 treated by the senior author were included. The mean age was 29 years (Range 0.08 – 79 years), with nearly twice (1.7x) as many female patients than males; 37 to 22. Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of those with hearing loss, 44% reported a return-to-normal. The rate of mortality was 1.69% and 10% experienced recurrence (mean follow-up 2.3 years, Range 0 – 15).
Conclusion : Symptomatic patients with arachnoid cysts of the CPA is a rare pathology that exhibit a proclivity for the female gender and commonly present with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for those with severe symptoms, surgical decompression can serve as an effective tool for symptom alleviation and abatement.
