Intraneural Ganglion of the Superficial Peroneal Nerve: A Case Report

Stamatis, Emmanouil D.; Manidakis, Nikolaos; Patouras, Paraskevas

doi:10.1053/j.jfas.2010.04.012

Cited by 20 publications

(23 citation statements)

References 13 publications

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“…Understanding the etiology of these lesions has allowed for the refinement of surgical techniques. 77,132,138 Contrary to the most popular form of treatment (cyst resection) or even a more radical approach (nerve resection with or without nerve grafting or nerve transfer), 14,17,18,23,24,48,57,78,91,95,104,105,108,155,162,164,171 we recommend treating the articular branch connection and/or the joint. Even with isolated nerve transfer, 91 the articular branch remains connected to the neighboring joint, which would conceivably allow for cyst recurrence.…”

Section: Surgical Managementmentioning

confidence: 99%

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

Desy

Wang²,

Elshiekh

et al. 2016

JNS

111

134

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615 Literature review J Neurosurg 125:615-630, 2016I ntraneural ganglion cysts are benign mucinous lesions that are formed within peripheral nerves and typically lead to symptoms and signs of peripheral neuropathy. Their pathogenesis has been controversial. Different treatments have been recommended. Outcomes have been disappointing and the recurrence rate high and underreported.Over the past 15 years, our group has provided substantial evidence to support a unifying articular (synovial) theory as the etiology for all intraneural ganglion cysts. In 2003, the senior author (R.J.S.) demonstrated that the prototypical intraneural cysts of the common peroneal nerve are joint derived. Cyst formation originates in the superior tibiofibular joint (STFJ) and propagates toward abbreviatioNs EMG = electromyography; NCS = nerve conduction studies; STFJ = superior tibiofibular joint. obJective The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. methods In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. resuLts In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation o...

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Section: Surgical Managementmentioning

confidence: 99%

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

Desy

Wang²,

Elshiekh

et al. 2016

JNS

111

134

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“…Of note, there were no recurrences in the 18 cases (of the 487 analyzed in this group) that were treated with resection of the cyst as well as the involved parent nerve ± nerve graft reconstruction (Warren, ; Clark, ; Campailla, ; Herrin et al, ; Tatagiba et al, ; Coakley et al, ; Gosk et al, ; Rezzouk and Durandeau, ; Sanger et al, ; Uchida et al, ; Lohmeyer et al, ; Stamatis et al, ; Chang and Shih, ; Cesmebasi et al, 2014; Ogose et al, ; Naam et al, ).…”

Section: Resultsmentioning

confidence: 91%

“…Twelve cases (19%) did not provide sufficient information to determine recurrence location. Of note, there were no recurrences in the 18 cases (of the 487 analyzed in this group) that were treated with resection of the cyst as well as the involved parent nerve 6 nerve graft reconstruction (Warren, 1946;Clark, 1961;Campailla, 1967;Herrin et al, 1986;Tatagiba et al, 1993;Coakley et al, 1995;Gosk et al, 2004;Rezzouk and Durandeau, 2004;Sanger et al, 2006;Uchida et al, 2006;Lohmeyer et al, 2007;Stamatis et al, 2010;Chang and Shih, 2012;Cesmebasi et al, 2014;Ogose et al, 2014;Naam et al, 2015). Group 2: Intraneural recurrence after articular branch ligation or disconnection (Fig.…”

Section: Location and Pattern Of Recurrencesmentioning

confidence: 92%

Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

et al. 2015

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The etiology of intraneural ganglion cysts has been poorly understood. This has resulted in the development of multiple surgical treatment strategies and a high recurrence rate. We sought to analyze these recurrences in order to provide a pathoanatomic explanation and staging classification for intraneural cyst recurrence. An expanded literature search was performed to identify frequencies and patterns in cases of intraneural ganglion cyst recurrences following primary surgery. Two univariate analyses were completed to identify associations between the type of revision surgery and repeat cyst recurrences. The expanded literature search found an 11% recurrence rate following primary surgery, including 64 recurrences following isolated cyst decompression (Group 1); six after articular branch resection (Group 2); and none following surgical procedures that addressed the joint (Group 3). Eight cases did not specify the type of primary surgery. In group 1, forty-eight of the recurrences (75%) were in the parent nerve, three involved only the articular branch, and one travelled along the articular branch in a different distal direction without involving the main parent nerve. In group 2, only one case (17%) recurred/persisted within the parent nerve, one recurred within a persistent articular branch, and one formed within a persistent articular branch and travelled in a different distal direction. Intraneural recurrences most commonly occur following surgical procedures that only target the main parent nerve. We provide proven or theoretical explanations for all identified cases of intraneural recurrences for an occult or persistent articular branch pathway.

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“…Since the first description of a peroneal nerve neuropathy by Sultan in 1921 [7], very few cases of the lower limb compression neuropathies have been described in the surgical literature [2]- [11]. Most of these cases have been described in adults but there have even been reports of such lesions compressing the CPN at the proximal tibio-fibular joint in as young as 12 years of age by Frank et al [6].…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis should include L5 nerve root lesion, a nerve pathology near the tendinous arch of the peroneal longus muscle, a neural sheath tumor and exostosis at the proximal lower leg [6] [9] [11] [18] [22].…”

Section: Discussionmentioning

confidence: 99%

Common Peroneal Nerve Palsy Secondary to a Proximal Tibiofibular Joint “Ganglion Cyst”—A Case Report and Review of Literature

Kukreja¹,

Telang²

2015

OJO

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Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy-a proximal tibio-fibular joint "ganglion cyst"; a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.

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Intraneural Ganglion of the Superficial Peroneal Nerve: A Case Report

Cited by 20 publications

References 13 publications

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature

Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

Common Peroneal Nerve Palsy Secondary to a Proximal Tibiofibular Joint “Ganglion Cyst”—A Case Report and Review of Literature

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