Cranial nerve rhizopathies caused by cerebellopontine angle mass lesions and coexisting neurovascular conflict: systematic review and case illustration

• CPA masses and NVC often coexist, driving cranial nerve rhizopathies • Epidermoids link to TN via compression and irritation, low NVC incidence. • Meningiomas and arachnoid cysts show higher NVC rates, often needing resection and MVD. • Surgery yields ∼ 95% symptom resolution, low recurrence and complication rates. Though reporting of these is somewhat heterogeneous, reducing reliability. • Dual pathology model stresses imaging, intraoperative assessment, and tailored therapy. Cranial nerve rhizopathies caused by CPA pathology are challenging to manage due to the region’s complex anatomy, which contains multiple cranial nerves and vascular structures. Both neurovascular conflict and compressive mass lesions may provoke symptoms, and their coexistence complicates diagnosis and treatment planning. This review aimed to evaluate cranial nerve rhizopathies associated with CPA mass lesions and coexisting NVC, focusing on lesion type, demographics, and rhizopathy pattern. We also report a rare case of multiple simultaneous CPA rhizopathies caused by both an arachnoid cyst and NVC. A strategic literature search identified 517 cases of CPA mass–related rhizopathies. Lesion type, patient demographics, rhizopathy distribution, and intraoperative NVC findings were analyzed. Chi-square testing assessed associations between lesion type and NVC. Epidermoid tumors were the most frequent lesions, followed by meningiomas, vestibular schwannomas, and arachnoid cysts. Trigeminal neuralgia (TN) was the dominant presentation, occurring at a younger mean age than idiopathic TN, with a marked female predominance. Rhizopathy type was significantly associated with lesion type. NVC was identified in 36.6% but did not influence surgical outcome. Surgery achieved symptom relief in 94.9% of cases, with recurrence in 1.35% and complications in 3.68%. Complication rates were not significantly different between mass types. CPA mass lesions frequently underlie cranial nerve rhizopathies. While NVC is common, it does not independently alter surgical outcome. Recognition of mass-specific rhizopathy patterns is crucial for preoperative imaging and operative planning. Tailored lesion-specific strategies yield excellent long-term results.