• Lawrance K Chung, Joel S Beckett, Vera Ong, Carlito Lagman, Daniel T Nagasawa, Isaac Yang, and Won Kim.
• Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
• World Neurosurg. 2017 Sep 1; 105: 689-696.

ObjectiveTo present an illustrative case of fourth ventricular epidermoid cyst and review the literature to identify predictors of surgical outcomes.MethodsA case of fourth ventricular epidermoid cyst is presented and a systematic review of 5 popular databases was performed by independent authors. Stepwise logistic regression was performed to identify clinical predictors of outcomes.ResultsA 21-year-old woman presented with 3 months of headaches and visual obscurations and was diagnosed with a multilobulated 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 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 (odds ratio, 1.19, 95% confidence interval, 1.003-4.785).ConclusionsOur 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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