Arachnoid Cyst of the Cerebellopontine Angle: A Systematic Literature Review.

OBJECTIVE: The role of surgical management of arachnoid cysts (AC) of the cerebellopontine angle (CPA) is uncertain. Limited to mostly case reports, this topic has remained controversial with varying contradictory recommendations in the literature. Herein we provide a comprehensive summary and analysis of the symptomology, operative-techniques, outcomes, and recurrence of all available surgical cases, to date. 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), with nearly twice (1.7x) as many females 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% recurred (mean follow-up 2.3-years, Range 0 - 15). CONCLUSION: Symptomatic patients with AC of the CPA is a rare disease that exhibits a proclivity for females and commonly presents 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 recovery.