The etiology and management of cystic adventitial disease

Desy, Nicholas M.; Spinner, Robert J.

doi:10.1016/j.jvs.2014.04.014

Cited by 97 publications

(182 citation statements)

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“…8,34,40,94,123,126 The more common extraneural/extra-adventitial ganglion cysts also arise from neighboring joints and can sometimes be mistakenly identified as intraneural or adventitial. Recently, our group has also demonstrated robust evidence to support the articular (synovial) theory as the etiology of cystic adventitial disease in arteries and veins, 29,129 an entity analogous to intraneural ganglion cysts. Finally, several cysts can form at the same time from the same joint, as demonstrated with a complex cyst from the STFJ or ulnohumeral joint leading to an intraneural, extraneural, and intraosseous cyst, 135,137 or combinations of intraneural and adventitial cysts from the STFJ.…”

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

Desy

Wang²,

Elshiekh

et al. 2016

JNS

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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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confidence: 77%

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

Desy

Wang²,

Elshiekh

et al. 2016

JNS

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111

134

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“…Based on the evidence we have provided in previous publications (Spinner et al, 2013;Desy and Spinner, 2014), we feel that a joint connection was present but unrecognized in both cases (i.e., to the hip and knee, respectively). This is supported by the para-articular location of the cysts, similar to others in the literature including the popliteal and femoral vessels individually (Campbell and Millar, 1985;Hall et al, 1985;Chen et al, 2013;Spinner et al, 2013;Michaelides et al, 2014).…”

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How to explain cystic adventitial disease coexisting in an adjacent artery and vein

et al. 2015

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“…This theory suggests that repeated trauma to the joints cause damage to the joint capsule, result in tracking of the synovial fluid to the adjacent arterial vasculature which can subsequently lead to development of the cysts. Desy et al substantiated this theory by identifying a number of cases where an interconnection was seen between the synovium and the cysts, as well as by the connection between different geniculate artery cysts (11). CAD in vessels that are not in immediate neighborhood of a joint is explained by Desy et al as caused by migration of synovial cells along the arterial vessel.…”

Section: Etiology and Pathophysiologymentioning

confidence: 98%

Cystic adventitial disease—case series and review of literature

Li¹,

King²,

Velasco³

et al. 2017

Ann. Transl. Med.

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Cystic adventitial disease (CAD) is a rare vascular disorder that involves the arteries and rarely the veins, most commonly found in the popliteal artery of male patients. Etiology of CAD is uncertain and currently without a consensus agreement. Clinically, the most common presenting symptom is claudication.Diagnosis requires a strong clinical suspicion in patients with intermittent claudication, but without other risk factors for atherosclerotic disease. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. CAD can rarely recur after treatment. Case presentation Case 1A 54-year-old male who presented after an abnormal ultrasound (US) with Doppler exam at an outside institution with a 2 months history of new, progressive right leg claudication. His medical history is significant for hypertension and a maternal history of fatal abdominal aortic aneurysm rupture. The patient states a history of trauma to the right knee of uncertain nature. He denies illicit drug use but confirms a long history of cigarette smoking. Review of systems is otherwise negative. On physical examination, no swelling, varicose veins or stiffness in the right leg were identified. The right pedal pulses were palpable but greatly reduced. The left leg is unremarkable. The initial abnormal Doppler US performed at an outside institution (image not available) reported a 1.5 cm right popliteal artery aneurysm with a possible dissection within this aneurysm and luminal narrowing. An urgent computed tomography angiography (CTA) abdomen and pelvis with runoff was performed which demonstrated a cystic structure intimately associated with the right above-theknee popliteal artery, causing near complete occlusion (Figures 1,2) without evidence of dissection. A presumptive diagnosis of cystic adventitial disease (CAD) is made at this time, and the patient was taken to the operating room for definitive diagnosis and management. A posterior surgical approach was taken and a cyst in the wall of the right popliteal artery was identified. The cyst was entered with the evacuation of viscous, jelly-like amber material. The entire cyst wall was resected. There was strong distal popliteal artery pulse status post cystectomy. The patient had an unremarkable recovery. Follow up with Doppler US performed at 2 and 4 months post-cystectomy showed a normal right popliteal artery, without evidence of cyst recurrence. Case 2A 58-year-old male developed an acute onset of left lower extremity claudication and numbness. There were no resting pain, skin ulcerations or prior history of claudication symptoms. On physical examination, the patient's right lower extremity pulses were within normal limits. The left lower extremity pedal pulses were palpable but reduced, and became nonpalpable with left knee flexion (positive Ishikawa sign). A Doppler US demonstrated an anechoic lesion intimately associat...

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The etiology and management of cystic adventitial disease

Cited by 97 publications

References 262 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

How to explain cystic adventitial disease coexisting in an adjacent artery and vein

Cystic adventitial disease—case series and review of literature

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