Can trauma cause tibial intraneural ganglion cysts at the superior tibiofibular joint?

2012 ◽  
Vol 25 (6) ◽  
pp. 785-787 ◽  
Author(s):  
Robert J. Spinner ◽  
Frank Crnkovich ◽  
Mohanad Ahmed Ibrahim Kobeal ◽  
Kimberly K. Amrami
Keyword(s):  
Intraneural Ganglion ◽  
Superior Tibiofibular Joint ◽  
Ganglion Cysts ◽  
Tibiofibular Joint

Expanding the spectrum of indirect trauma and superior tibiofibular joint-related intraneural ganglion cysts

2014 ◽  
Vol 27 (8) ◽  
pp. 1130-1132 ◽  
Author(s):  
Alper Cesmebasi ◽  
B. Matthew Howe ◽  
Kimberly K. Amrami ◽  
Robert J. Spinner
Keyword(s):  
Intraneural Ganglion ◽  
Indirect Trauma ◽  
Superior Tibiofibular Joint ◽  
Ganglion Cysts ◽  
Tibiofibular Joint

Joint Outcomes Following Surgery for Superior Tibiofibular Joint-Associated Peroneal Intraneural Ganglion Cysts

Neurosurgery ◽  
2019 ◽  
Author(s):  
Thomas J Wilson ◽  
Jonathan J Stone ◽  
B Matthew Howe ◽  
Michael G Rock ◽  
Robert J Spinner
Keyword(s):  
Intraneural Ganglion ◽  
Superior Tibiofibular Joint ◽  
Ganglion Cysts ◽  
Tibiofibular Joint

The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

2006 ◽  
Vol 36 (4) ◽  
pp. 281-292 ◽  
Author(s):  
Robert J. Spinner ◽  
Ali Mokhtarzadeh ◽  
Terry K. Schiefer ◽  
Kartik G. Krishnan ◽  
Michel Kliot ◽  
...  
Keyword(s):  
Intraneural Ganglion ◽  
Superior Tibiofibular Joint ◽  
Ganglion Cysts ◽  
Tibiofibular Joint

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

2007 ◽  
Vol 107 (2) ◽  
pp. 296-307 ◽  
Author(s):  
Robert J. Spinner ◽  
Kimberly K. Amrami ◽  
Alexandra P. Wolanskyj ◽  
Nicholas M. Desy ◽  
Huan Wang ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Cyst Formation ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Articular Branch ◽  
Superior Tibiofibular Joint ◽  
Tibiofibular Joint ◽  
Joint Connection ◽  
Articular Theory

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 cases together with data obtained from a retrospective review of the authors' clinical material and findings reported in the literature provide firm evidence for mechanisms underlying intraneural ganglia formation. Thus, expansion of the authors' unified articular theory permits understanding and elucidation of unusual presentations of intraneural cysts. Whereas an articular connection and fluid following the path of least resistance was pivotal, the authors now incorporate dynamic aspects of cyst formation due to pressure fluxes. These basic principles explain patterns of ascent, cross-over, and descent down terminal nerve branches based on articular connections, paths of diminished resistance to fluid flow within recognized anatomical compartments, and the effects of fluctuating pressure gradients.

scholarly journals Peroneal and Tibial Intraneural Ganglion Cysts in the Knee Region: A Technical Note

2010 ◽  
Vol 67 (3) ◽  
pp. ons71-ons78 ◽  
Author(s):  
Robert J. Spinner ◽  
Marie-Noëlle Hébert-Blouin ◽  
Kimberly K. Amrami ◽  
Michael G. Rock
Keyword(s):  
Peroneal Nerve ◽  
Neck Region ◽  
Technical Note ◽  
Intraneural Ganglion ◽  
Articular Branch ◽  
Knee Region ◽  
Improved Outcomes ◽  
Ganglion Cysts ◽  
Tibiofibular Joint ◽  
Articular Theory

Abstract BACKGROUND: Recent research has resulted in an improved understanding of the pathogenesis and treatment of intraneural ganglia, particularly with respect to the most common form, the peroneal nerve at the fibular neck region. OBJECTIVE: To outline the mechanism for the development and propagation of intraneural ganglia located in the knee region, along with their treatment, as well as highlight how shared principles can be exploited for successful treatment of the more commonly occurring peroneal intraneural ganglia. METHODS: A surgical approach has been developed for peroneal intraneural cysts based on the pathogenesis. The treatment of the less common tibial intraneural cysts is designed along the same principles. RESULTS: A strategy consisting of (1) disarticulation (resection) of the superior tibiofibular joint (ie, the source), (2) disconnection of the articular branch connection (ie, the conduit), and (3) decompression (rather than resection) of the cyst has improved outcomes and eliminated intraneural recurrences in peroneal intraneural cysts. These same principles and techniques can be applied to the rarer tibial intraneural ganglia derived from the same joint. The mechanism of development and propagation for intraneural cysts in the knee region as well as a surgical technique and its rational are described and illustrated. CONCLUSION: Understanding the joint-related basis of intraneural cysts leads to simple targeted surgery that addresses the joint, its articular branch, and the cyst. The success of the shared surgical strategy for both peroneal and tibial intraneural ganglia confirms the principles of the unifying articular theory.

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

2007 ◽  
Vol 22 (6) ◽  
pp. 1-12
Author(s):  
Robert J. Spinner ◽  
Kimberly K. Amrami ◽  
Alexandra P. Wolanskyj ◽  
Nicholas M. Desy ◽  
Huan Wang ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Cyst Formation ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Articular Branch ◽  
Superior Tibiofibular Joint ◽  
Tibiofibular Joint ◽  
Joint Connection ◽  
Articular Theory

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 cases together with data obtained from a retrospective review of the authors' clinical material and findings reported in the literature provide firm evidence for mechanisms underlying intraneural ganglia formation. Thus, expansion of the authors' unified articular theory permits understanding and elucidation of unusual presentations of intraneural cysts. Whereas an articular connection and fluid following the path of least resistance was pivotal, the authors now incorporate dynamic aspects of cyst formation due to pressure fluxes. These basic principles explain patterns of ascent, cross-over, and descent down terminal nerve branches based on articular connections, paths of diminished resistance to fluid flow within recognized anatomical compartments, and the effects of fluctuating pressure gradients.

Recurrent intraneural ganglion cyst of the tibial nerve

2000 ◽  
Vol 92 (2) ◽  
pp. 334-337 ◽  
Author(s):  
Robert J. Spinner ◽  
John L. D. Atkinson ◽  
C. Michel Harper ◽  
Doris E. Wenger
Keyword(s):  
Tibial Nerve ◽  
Ganglion Cyst ◽  
Symptomatic Relief ◽  
Proximal Tibiofibular Joint ◽  
Cell Of Origin ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Content Type ◽  
Ganglion Cysts ◽  
Tibiofibular Joint

✓ Different theories have evolved to explain the pathogenesis and the cell of origin of intraneural ganglion cysts. Reportedly only three cases of intraneural ganglion of the tibial nerve have been located within the popliteal fossa, and all of these were thought to arise within the nerve. The authors report a case of a recurrent tibial intraneural ganglion in which a connection to the proximal tibiofibular joint was demonstrated on magnetic resonance (MR) images and at surgery. Surgical ligation of the articular branch and evacuation of the cyst led to symptomatic relief, and an MR image obtained 1 year after surgery documented no recurrence. This case reinforces the fact that surgeons need to consider and search for an articular connection in all cases of intraneural ganglia, especially in those that have recurred.

scholarly journals Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Akın Onat
Keyword(s):  
Peroneal Nerve ◽  
Imaging Modality ◽  
Axonal Neuropathy ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Articular Branch ◽  
Ankle Eversion ◽  
Adjacent Structures ◽  
Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

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