Management of Rare Atlantoaxial Synovial Cyst Case with Extension to the Cerebellopontine Angle: Illustrative Case

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2023 Oct 30

PMID 37903420

Authors

Shawn Dsouza

Vikram Seshadri

Harsh P Shah

Jan T Hachmann

R Scott Graham

Affiliations

Soon will be listed here.

Abstract

Background: Synovial cysts are a common finding in degenerative spine disease, most frequently involving the facet joints of the lumbar spine. Synovial cysts are less common in the cervical spine and rarely involve the atlantoaxial junction.

Observations: In this case report, the authors detail a unique presentation of a left atlantoaxial synovial cyst with large intracranial extension into the cerebellopontine angle causing progressive cranial nerve palsies resulting in tinnitus, vertigo, diminished hearing, gait imbalance, left trigeminal hypesthesia, left facial weakness, and dysarthria. The patient underwent a retromastoid craniectomy for resection of the synovial cyst, resulting in improvement and resolution of symptoms. Follow-up occurred at 6 weeks, 3 months, and 5 months postoperatively without recurrence on imaging.

Lessons: The authors describe acute and long-term management of a unique presentation of an atlantoaxial synovial cyst including retromastoid craniectomy, intervals for follow-up for recurrence, and possible treatment options in cases of recurrence. A systematic literature review was also performed to explore all reported cases of craniocervical junction synovial cysts and subsequent surgical management.

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