Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory

Spinner, Robert J.; Atkinson, John L.D.; Tiel, Robert L.

doi:10.3171/jns.2003.99.2.0330

Cited by 247 publications

(259 citation statements)

References 129 publications

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“…Given the unifying articular theory, 32 we predicted that it should be possible to treat suprascapular intraneural ganglion cysts in the same way as paralabral cysts-with repair of the capsulolabral defect in the joint of origin. Here, we present 2 cases of suprascapular intraneural ganglion cysts, scrutinized with high-resolution MRI and treated with arthroscopic repair of an associated paralabral tear, without resection of the articular branch.…”

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The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Prasad

Spinner

Smith³

et al. 2015

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OBJECT High-resolution magnetic resonance imaging (MRI) can distinguish between intraneural ganglion cysts and paralabral (extraneural) cysts at the glenohumeral joint. Suprascapular intraneural ganglion cysts share the same pathomechanism as their paralabral counterparts, emanating from a tear in the glenoid labrum. The authors present 2 cases to demonstrate that the identification and arthroscopic repair of labral tears form the cornerstone of treatment for intraneural ganglion cysts of the suprascapular nerve. METHODS Two patients with suprascapular intraneural ganglion cysts were identified: 1 was recognized and treated prospectively, and the other, previously reported as a paralabral cyst, was identified retrospectively through the reinter-pretation of high-resolution MR images. RESULTS Both patients achieved full functional recovery and had complete radiological involution of the intraneural ganglion cysts at the 3-month and 12-month follow-ups, respectively. CONCLUSIONS Previous reports of suprascapular intraneural ganglion cysts described treatment by an open approach to decompress the cysts and resect the articular nerve branch to the glenohumeral joint. The 2 cases in this report demonstrate that intraneural ganglion cysts, similar to paralabral cysts, can be treated with arthroscopic repair of the glenoid labrum without resection of the articular branch. This approach minimizes surgical morbidity and directly addresses the primary etiology of intraneural and extraneural ganglion cysts.

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The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

Prasad

Spinner

Smith³

et al. 2015

FOC

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“…All shared the cardinal imaging and operative features of peroneal and tibial intraneural ganglia-a cyst extending from a degenerate superior tibiofibular joint along an articular branch via an intraepineurial dissection following the path of least resistance. In Case 1 there was also evidence of coexistent extraneural extension of the cyst into muscle and in Case 2 into vascular adventitiapatterns we have seen previously 33,36 that confirm the origin of these cysts in a pathological joint capsule. Our cases also exhibited two other unusual features: atypical cyst extension and cyst regression.…”

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confidence: 54%

“…Similarly, a small cyst neck at the articular branch connection becomes expansive more proximally. Such is the case in the common peroneal nerve proximal to the fibular tunnel 32,33 and in the tibial nerve within the popliteal fossa. 35 With increased intraarticular pressure and perhaps associated inflammatory change, cyst fluid may extend from the proximal leg to as high as the buttock.…”

Section: Pressure Fluxes and Dynamic Appearancesmentioning

confidence: 99%

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2007

Neurosurgical FOCUS

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NTIL recently, descriptions of intraneural ganglia have centered on their static appearances. The unifying articular or "synovial" theory 33 we initially proposed was based on critical analyses of clinical, operative, and imaging observations as well as on assessments of reported cases. Using this theory, we sought to explain the most common form of intraneural cyst-that affecting the peroneal nerve. 32 More recently, the theory was validated with respect to the tibial nerve 31,35 and corroborated by other authors as well. 27 In short, we have shown that intraneural ganglia have characteristic, stereotypical appearances. 34,35 For example, peroneal and tibial intraneural ganglia arise from the anterior 8,32 and posterior 31,35 aspects of the superior tibiofibular joint, respectively, and extend intraepineurially via their own articular branches into the parent nerve, sometimes as far proximal as the buttock! Object. The pathogenesis of intraneural ganglia has been a controversial issue for longer than a century. Recently the authors identified a stereotypical pattern of occurrence of peroneal and tibial intraneural ganglia, and based on an understanding of their pathogenesis provided a unifying articular explanation. Atypical features, which occasionally are observed, have offered an opportunity to verify further and expand on the authors' proposed theory.Methods. Three unusual cases are presented to exemplify the dynamic features of peroneal and tibial intraneural ganglia formation.Results. Two patients with a predominant deep peroneal nerve deficit shared essential anatomical findings common to peroneal intraneural ganglia: namely, 1) joint connections to the anterior portion of the superior tibiofibular joint, and 2) dissection of the cyst along the articular branch of the peroneal nerve and proximally. Magnetic resonance (MR) images obtained in these patients demonstrated some unusual findings, including the presence of a cyst within the tibial and sural nerves in the popliteal fossa region, and spontaneous regression of the cysts, which was observed on serial images obtained weeks apart. The authors identified a clinical outlier, a case that could not be understood within the context of their previously reported theory of intraneural ganglion cyst formation. Described 32 years ago, this patient had a tibial neuropathy and was found at surgery to have tibial, peroneal, and sciatic intraneural cysts without a joint connection. The authors' hypothesis about this case, based on their unified theory, was twofold: 1) the lesion was a primary tibial intraneural ganglion with proximal extension followed by sciatic cross-over and distal descent; and 2) a joint connection to the posterior aspect of the superior tibiofibular joint with a remnant cyst within the articular branch would be present, a finding that would help explain the formation of different cysts by a single mechanism. The authors proved their hypothesis by careful inspection of a recently obtained postoperative MR image.Conclusions. These three cas...

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“…Identification of the joint connection has important clinical implications. If it is not addressed, complications such as cyst recurrence, incomplete patient recovery, and suboptimal operative outcomes may occur (1,3,4).…”

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Evaluation of intraneural ganglion cysts using three‐dimensional fast spin echo‐cube

Shahid

Spinner

Skinner

et al. 2010

Magnetic Resonance Imaging

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Purpose: To compare conventional two-dimensional fast spin echo (FSE) MRI sequences with a three-dimensional FSE extended echo train acquisition method, known as Cube, in the evaluation of intraneural ganglion cysts. Also, to demonstrate that Cube enables the consistent identification and thorough characterization of the cystic joint connection, and therefore improves patient care by superior preoperative planning. Materials and Methods:Six patients with intraneural ganglia in the knee region (five involving the peroneal and one the tibial nerve) were evaluated using both conventional FSE MR sequences and the Cube sequence. Studies were interpreted by the consensus of three board certified musculoskeletal radiologists and one peripheral nerve neurosurgeon. Surgical correlation was available in five of the six cases.Results: Both imaging methods demonstrated the cysts and at least part of their joint connections after variable amount of postprocessing. Cube proved superior to conventional imaging in its ability to acquire isotropic data that could easily be reconstructed in any plane and its ability to resolve fine anatomical details. Conclusion:Cube is a new MR pulse sequence that enables the consistent identification of the intraneural ganglion cyst joint connection. We believe that improved visualization and characterization of the entire cyst will improve patient outcomes by facilitating more accurate surgical intervention.

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Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory

Cited by 247 publications

References 129 publications

The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

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Evaluation of intraneural ganglion cysts using three‐dimensional fast spin echo‐cube

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