Intraneural ganglion cysts of the lower limb

Abstract

Background Intraneural ganglion cysts are rare. They affect the peripheral nerves. According to the most widely accepted theory (articular/synovial theory), the cysts are formed from a capsular defect of an adjacent joint, so that synovial fluid spreads along the epineurium of a nerve branch. This leads to diverse neurological symptoms. We will illustrate this disease based on three of our own cases. Methods Patients were examined between 2011 and 2018 using lower limb MRI. MRI scans were also performed for the follow-up examinations. Case studies and Discussion The patients had many symptoms. We were able to accurately detect the intraneural ganglion cysts on MRI and provide the treating surgeons with the basis for the operation to be performed. The success of surgical therapy depends on the resection of the nerve endings supplying the joint as the only way to treat the origin of the disease and prevent recurrence. Based on our case studies, we can support the commonly favored articular/synovial theory. Key Points: Citation Format

Unusual case of an intraneural ganglion cyst of the tibial nerve

“…Intraneural ganglion cysts are a rare benign pathology caused by the accumulation of mucinous fluid in the epineurium of peripheral nerves. 1,2 Their aetiology arise from the unifying articular (synovial) theory, which postulates that the cysts are formed from a capsular defect of an adjacent joint such that synovial fluid propagates along the epineurium of an articular nerve branch to the parent nerve. [2][3][4] They can lead to compression of the adjacent nerve structures, resulting in pain, weakness, dysaesthesia and muscular atrophy.…”

“…[2][3][4] They can lead to compression of the adjacent nerve structures, resulting in pain, weakness, dysaesthesia and muscular atrophy. 1 We present an unusual anatomical case of an intraneural ganglion cyst of the tibial nerve which coursed deep to the vascular bundle of the popliteal fossa resulting in compressive symptoms.…”

“…Intraneural ganglion cysts are a rare condition whose aetiology has only recently been understood by the articular (synovial) theory. 1 Synovial fluid from a capsular defect dissects along the epineurium of an articular nerve branch through the path of least resistance into a major parent nerve. [2][3][4] The vast majority of intraneural ganglion cysts originate from the superior tibiofibular joint and extend into the common peroneal nerve.…”

“…2,[6][7][8] MRI is the gold-standard modality for assessing intraneural ganglion cysts. 1 Its appearance on MRI is usually that of a homogeneous multilobulated soft tissue formation with fluid signals. 1,8 MRI allows for clear characterization of its relationship with nervous and vascular structures as well as its path from the joint of origin, which helps to guide intervention.…”

A Case Series of Intraneural Ganglion Cyst Involving the Common Peroneal Nerve: Potential Cause for Foot Drop

“…of peripheral nerves, with the majority of cases occurring in the para-articular or articular areas [1][2][3]. The common peroneal nerve (CPN) is the most usually impacted nerve in the body, Intraneural ganglion cysts (IGC) are non-neoplastic mucinous cysts that form when thick mucinous fluid accumulates in the epineurium while the ulnar and radial nerves are the most typically affected nerves in the upper extremities [1][2][3][4][5][6]. Because of the displacement and compression of the nerve fascicles, intraneural ganglion cysts often induce signs and symptoms of peripheral neuropathy.…”