Hypoglossal nerve palsy due to periarticular cyst extending into hypoglossal canal: a systematic review.

OBJECTIVE

To compile and evaluate characteristics of patients with hypoglossal canal synovial cysts reported in the literature.

BACKGROUND

Synovial cysts are benign soft-tissue masses that are rarely located in the occipitocervical junction and surrounding anatomical location. They may lead to compression of the hypoglossal nerve. Typically, cysts in this region remain asymptomatic, and biopsies of the hypoglossal canal have high risks, so imaging is a very important diagnostic tool.

METHODS

A systematic search of PubMed, Medline, Embase, Scopus, and Web of Science was conducted in line with PRISMA guidelines to identify studies on patients with hypoglossal nerve palsy due to synovial cysts. The search strategy followed the authors' predefined PROSPERO protocol. (CRD42024577602)

RESULTS

Data were reviewed from 29 patients with hypoglossal nerve palsy due to synovial cysts across 18 studies from 1998 to 2024. There were 12 (41.38%) males and 16 (55.17%) females. The median (range) patient age was 67.0 (51.0-89.0) years. In terms of presenting symptoms, 25 (86.21%) exhibited unilateral tongue atrophy or deviation. Additionally, 9 patients (31.03%) reported swallowing difficulties or dysphagia, and 18 patients (62.07%) experienced slurred speech or dysarthria. In total, 14 (48.27%) patients underwent surgery, while 14 (48.27%) patients received conservative management.

CONCLUSION

Synovial cysts within the hypoglossal canal are benign lesions that typically appear as T1 hypointense or isointense and T2 hyperintense with peripheral enhancement on magnetic resonance imaging (MRI). Surgical intervention showed very limited improvement in symptoms, particularly when nerve damage was severe and irreversible, while conservative management rarely resulted in cyst regression or symptom relief, and no significant improvement in hypoglossal nerve function.