Cerebellopontine angle epidermoid cyst masquerading as trigeminal neuralgia: A rare presentation and surgical outcome

Cerebellopontine (CP) angle epidermoid cysts are rare, benign, slow-growing intracranial lesions that arise from ectodermal inclusions during embryogenesis. They often present with symptoms caused by compression of adjacent structures, with trigeminal neuralgia being an uncommon presentation. A 19-year-old female presented with a 1-month history of tingling sensation on the right side of her face. MRI of the brain revealed an extra-axial cystic lesion at the right CP angle extending into the ambient cistern. The lesion appeared hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and dirty hyperintense on FLAIR, with diffusion restriction on DWI and no blooming on SWI. It caused a mass effect with compression of the right pons and trigeminal nerve. The patient underwent microsurgical resection of the cyst, and histopathological findings confirmed the diagnosis of an epidermoid cyst. Postoperatively, the patient showed symptomatic improvement and was advised long-term follow-up. This case emphasizes the importance of advanced imaging in diagnosing rare intracranial lesions and highlights surgical resection as an effective treatment for CP angle epidermoid cysts presenting with atypical symptoms.