Minimally invasive treatment strategy combining a partial resection with cyst aspiration and subsequent Gamma Knife radiosurgery for cystic hypoglossal neurinoma in an older adult: illustrative case.

backgroundHypoglossal neurinomas are rare tumors that pose management challenges, particularly when they contain cystic components. While total removal remains the standard treatment, resection can be excessively invasive for older adults. This report describes a case of cystic hypoglossal neurinoma successfully treated through a partial resection with cyst aspiration followed by Gamma Knife radiosurgery (GKRS). OBSERVATIONS: A male aged 81 years presented with progressive dysarthria and dysphagia secondary to left hypoglossal nerve palsy. MRI revealed a cystic lesion compressing the medulla and a solid component within the left hypoglossal canal. Cyst aspiration was performed to alleviate potentially life-threatening lower cranial nerve palsy, followed by GKRS. At 21 months, marked cyst shrinkage was observed after a transient post-GKRS expansion, with no further interventions required. LESSONS: A treatment strategy combining cyst aspiration and GKRS was useful for managing cystic hypoglossal neurinoma in an older adult. Minimally invasive management should be considered for older adults with comorbidities who are at increased risk for postoperative complications. https://thejns.org/doi/10.3171/CASE25821.