Synovial cysts: Clinical and neuroradiological aspects

Artico, Marco; Cervoni, Luigi; Carloia, S.; Stevanato, Giorgio; Mastantuono, M.; Nucci, Francesco

doi:10.1007/bf01844747

Cited by 51 publications

(34 citation statements)

References 28 publications

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“…In nerve compression due to extraneural cysts, neurological signs come later and are of lower intensity compared to intraneural lesions [1]. Another possible mechanism of neurologic deficit is anterior compartment syndrome due to extension of a ganglion from the PTFJ to the anterior leg compartment [17,20].…”

Section: Discussionmentioning

confidence: 99%

Proximal tibiofibular joint synovial cyst—one pathology with three different presentations

Mortazavi

Farzan

Asadollahi

2005

Knee Surg Sports Traumatol Arthr

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Synovial cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar fashion and may be difficult to diagnose clinically. We report three cases of such synovial cysts: (1) the synovial cyst presented as an asymptomatic lump distal to lateral joint line of the knee; (2) the synovial cyst presented as a mass fluctuating in size with intermittent symptoms; (3) a man with a large mass in proximal anterior leg and drop foot. The patients were operated. The first and the third patients were treated successfully without recurrence, and complete recovery of the proneal nerve in third case ensued. The synovial cyst recurred in the second case; however, the patient refused a second operation. Age distribution and clinical manifestation of extraneural proximal tibiofibular joint synovial cyst is discussed in the light of relevant literature.

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Section: Discussionmentioning

confidence: 99%

Proximal tibiofibular joint synovial cyst—one pathology with three different presentations

Mortazavi

Farzan

Asadollahi

2005

Knee Surg Sports Traumatol Arthr

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“…The literature indicates a minor female preponderance of 53 % with an age range of 16±81 years (mean age 57 years) [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17]. A review of 26 published cases showed a female predominance of 66 % [17].…”

Section: Age and Gendermentioning

confidence: 94%

“…It was not possible considering clinical features alone to distinguish these patients from those undergoing MR examinations for other low back problems. The majority of patients present with chronic low back pain with 84 % exhibiting radicular symptoms [6,11,12,15,18]. In one series of 45 cases most were considered asymptomatic at the time of diagnosis [5] which differs from the current series.…”

Section: Clinical Featuresmentioning

confidence: 96%

MR imaging of lumbar facet joint synovial cysts

et al. 2000

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The increasing application of magnetic resonance (MR) imaging of the spine has raised the awareness of lumbar facet synovial cysts (LFSC). This well recognised, yet uncommon condition, presents with low back pain and radiculopathy due to the presence of an extradural mass. The commonest affected level is L4/5 with a mild degenerative spondylolisthesis a frequent associated finding. MR imaging is the technique of choice to detect and diagnose a LFSC. This pictorial essay, drawing on experience of 43 cases seen in 40 patients, illustrates the spectrum of appearances that can be encountered and suggest differing causes for the variable signal characteristics exhibited. Computed tomography (CT) can be of value in some cases to aid interpretation of the MR images. In addition, CT facet arthrography by injection of air or iodinated non-ionic contrast medium may be used to confirm the diagnosis in doubtful cases as well as noting whether the patients presenting symptoms can be provoked. A comprehensive review of the existing literature is presented.

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“…Different radiographic techniques have been used to evaluate ganglion cysts and their possible joint connections at this anatomic location (Schwimmer et al, 1985;Lee et al, 1987;Burk et al, 1988;Janzen et al, 1994;Artico et al, 1997;Kim et al, 2004;McCarthy and McNally, 2004). Ultrasound (Prevot et al, 1990;Leitjen et al, 1992;Lang et al, 1994;Dubuisson and Stevenaert, 1996;Aulisa et al, 1998) and CT (Firooznia et al, 1983;Pazzaglia, et al, 1989;Gambari et al, 1990;Antonini et al, 1991) have both been used in an attempt to characterize these cysts and their origins but have fallen short when compared to optimized MRI techniques and the superior soft-tissue contrast and high spatial resolution (Leon and Marano, 1987;Coakley et al, 1995;Kuntz et al, 1996;Uetani et al, 1998;Grant et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Application of three-dimensional rendering in joint-related ganglion cysts

2006

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The origin of para-articular cysts is poorly understood and controversial. The relatively common, simple (extraneural) cysts are presumed to be derived from joints, although joint connections are not always established. Rarer complex cysts are thought by many to form de novo within nerves (intraneural ganglion cysts) or within vessels (adventitial cysts) (degenerative theory). We believe that these simple and complex ganglion cysts are joint-related (articular theory). Joint connections are often not readily appreciated with routine imaging or at surgery. Not identifying and/or treating joint connections frequently leads to cyst recurrence. More sophisticated imaging may enhance visualization of these joint connections. We created a 3D rendering technique to assess potential joint connections of simple and complex cysts localized to the knee and superior tibiofibular joints in patients with fibular (peroneal) neuropathy. Two- and three-dimensional data sets from MRI examinations were segmented semiautomatically by signal intensity with further refinement based on interaction with the user to identify specific anatomic structures, such as small nerves and vessels on serial images. The bone, cysts, nerves, and vessels were each assigned different color representations, and 3D renderings were created in ANALYZE using the data sets closest to isotropic (voxel with equal length in all dimensions) resolution as the primary background rendering. We selected four cases to illustrate the spectrum of pathology. In all of these cases, we demonstrated joint connections and correlated imaging and operative findings. Surgery addressing the cyst and the joint connection resulted in excellent outcomes; postoperative MRIs done more than 6 months later confirmed that there was no recurrence. In addition to highlighting the important relationship of these cysts to neighboring anatomic structures, this 3D technique allows visualization of "occult" connections not readily appreciated with standard MR imaging. We believe that these joint-related cysts have a common pathogenesis; they dissect through a capsular rent and follow the path of least resistance; they may form simple cysts by dissecting out into the soft tissue, or more complex cysts by dissecting within the epineurium of nerves or adventitia of vessels (along an articular branch), or various combinations of all of these types of cysts. Understanding the pathogenesis for cyst formation will improve surgical management and outcomes. We have adapted this 3D technique to enhance the visualization of cysts occurring at other joints.

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Synovial cysts: Clinical and neuroradiological aspects

Cited by 51 publications

References 28 publications

Proximal tibiofibular joint synovial cyst—one pathology with three different presentations

Proximal tibiofibular joint synovial cyst—one pathology with three different presentations

MR imaging of lumbar facet joint synovial cysts

Application of three-dimensional rendering in joint-related ganglion cysts

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