Predictors of outcomes in fourth ventricular epidermoid cysts: A case report and a review of literature.

OBJECTIVE: To present an illustrative case of fourth ventricular epidermoid cyst and review the literature to identify predictors of surgical outcomes. METHODS: A case of fourth ventricular epidermoid cyst is presented and a systematic review of five popular databases was performed by independent authors. Stepwise logistic regression was performed to identify clinical predictors of outcomes. RESULTS: A 21-year-old female presented with 3 months of headaches and visual obscurations and was diagnosed with a multi-lobulated mass in the fourth ventricle. The patient underwent suboccipital craniotomy. Complete removal of the mass was achieved and the final diagnosis was consistent with an epidermoid cyst. The systematic review identified a total of 23 studies that reported 37 patients. Mean age was 42.8 years. Mean length of time between symptom onset and diagnosis was 4.43 years. Age (p = 0.049) and duration of symptoms (p < 0.001) were significantly different between patients who experienced symptom improvement and those who did not. Duration of symptom onset to diagnosis was a significant predictor of poor outcomes (OR: 1.19, 95% CI: 0.209-0.997). CONCLUSIONS: Our review found that in patients with fourth ventricular epidermoid cysts, unfavorable outcomes were predicted by older age and by longer intervals from symptom onset to diagnosis. Clinicians should maintain a high index of suspicion for fourth ventricular epidermoid cysts in patients presenting with cerebellar signs and visual disturbances.