Intraneural ganglion cysts of the peroneal nerve

Intraneural ganglion cysts are nonneoplastic, mucinous cysts within the epineurium of peripheral nerves which usually involve the peroneal nerve at the knee. A 37-year-old female presented with progressive left buttock and posterior thigh pain. Magnetic resonance imaging revealed a sciatic nerve mass at the sacral notch which was subsequently revealed to be an intraneural ganglion cyst. An intraneural ganglion cyst confined to the proximal sciatic nerve has only been reported once prior to 2009.

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

Operative Neurosurgery ◽

10.1227/01.neu.0000374683.91933.0e ◽

2010 ◽

Vol 67 (3) ◽

pp. ons71-ons78 ◽

Cited By ~ 4

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.

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Peroneal intraneural ganglia

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.6.17 ◽

2007 ◽

Vol 22 (6) ◽

pp. 1-10 ◽

Cited By ~ 16

Author(s):

Robert J. Spinner ◽

Nicholas M. Desy ◽

Michael G. Rock ◽

Kimberly K. Amrami

Keyword(s):

Peripheral Nerve ◽

Treatment Outcomes ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Intraneural Ganglion ◽

Ganglion Cysts ◽

Stepwise Method ◽

The Subject ◽

The Common

✓The common peroneal nerve is the peripheral nerve most often affected by intraneural ganglion cysts. Although the pathogenesis of these cysts has been the subject of controversy in the literature, it is becoming increasingly evident that they are of articular origin. Recent recognition of this fact has proven to be significant in reducing recurrences and improving treatment outcomes for patients. The authors present a stepwise method of assessing and treating peroneal intraneural ganglion cysts.

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A case of intraneural ganglion cyst of the peroneal nerve: A rapid recovery after incision of cyst

Journal of Analytical Research in Clinical Medicine ◽

10.15171/jarcm.2019.024 ◽

2019 ◽

Vol 7 (4) ◽

pp. 129-132

Author(s):

Fardin Mirzatolooei ◽

Ali Tabrizi ◽

Seyed Amir Mahlisha Kazemi-Shishavan

Keyword(s):

Peroneal Nerve ◽

Ganglion Cyst ◽

Foot Drop ◽

Intraneural Ganglion ◽

Intraneural Ganglion Cyst ◽

Course Of Disease ◽

Post Surgery ◽

Ganglion Cysts ◽

Symptoms And Signs

Introduction : Intraneural ganglion cysts (INGCs) are an infrequent cause of foot drop. INGCs are benign mucinous cysts within the epineurium of peripheral nerves, which are usually observed in the peroneal nerve at the knee typically leading to symptoms and signs of peripheral neuropathy. Case Report: A 40-year-old man with foot drop who had undergone a spinal study for discopathy was examined in this study. The patient had peroneal nerve compression at the neck of the fibula resulting from an extra neural cyst. Surgical exploration revealed an intraneural cyst. Epineurium was incised and the cyst was evacuated. In a two-week post-surgery follow up, his foot drop had improved partially and the remainder of his symptoms resolved. Conclusion: Awareness of the intraneural cysts of peroneal nerve as a cause for foot drop is important because early surgical intervention could reverse the course of disease.

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Intraneural Ganglion cyst of The Deep Peroneal Nerve Causing Rapidly Progressive Foot Drop

International Journal of Orthopaedics Research ◽

10.33140/ijor.04.01.02 ◽

2021 ◽

Vol 4 (1) ◽

Keyword(s):

Peroneal Nerve ◽

Ganglion Cyst ◽

Nerve Fibers ◽

Surgical Decompression ◽

Foot Drop ◽

Leg Pain ◽

Intraneural Ganglion ◽

Intraneural Ganglion Cyst ◽

Ganglion Cysts ◽

Post Operation

Intraneural ganglion cysts are a relatively uncommon cause of peroneal nerve palsy. Patient’s typically present with weakness or absent ankle dorsiflexion, knee or leg pain, and paresethesia. Surgical decompression is widely accepted as the first line treatment for intraneural ganglion cysts of the peroneal nerve, with earlier intervention associated with better functional outcomes. Here, we describe the case of a 57-year-old male found to have a intraneural ganglion cyst of the peroneal nerve, three months after the onset of symptoms, including eventual complete foot drop. He underwent surgical decompression of the cyst. The intraneural ganglion cyst was found to be intricately involved with the nerve fibers, and the patient still does not have the ability to dorsiflex the affected ankle one month post-operation.

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Deep Peroneal Nerve Palsy Caused by an Extraneural Ganglion Cyst: A Rare Case

Case Reports in Orthopedics ◽

10.1155/2015/861697 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Dimitrios Nikolopoulos ◽

George Safos ◽

Neoptolemos Sergides ◽

Petros Safos

Keyword(s):

Peroneal Nerve ◽

Ganglion Cyst ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Peripheral Neuropathies ◽

Tibiofibular Syndesmosis ◽

Deep Peroneal Nerve ◽

Intraneural Ganglion ◽

Ganglion Cysts ◽

The Common

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

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Immediate Nerve Transfer for the Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review

Plastic Surgery ◽

10.1177/2292550317694842 ◽

2017 ◽

Vol 25 (1) ◽

pp. 54-58 ◽

Cited By ~ 3

Author(s):

I. Ratanshi ◽

T. A. Clark ◽

Jennifer L. Giuffre

Keyword(s):

Peroneal Nerve ◽

Nerve Palsy ◽

Common Peroneal Nerve ◽

Ankle Dorsiflexion ◽

Foot Drop ◽

Peroneal Nerve Palsy ◽

Intraneural Ganglion ◽

Motor Branch ◽

Ganglion Cysts ◽

The Common

Intraneural ganglion cysts that occur within the common peroneal nerve are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presents with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to the flexor hallucis longus to a motor branch of the anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, and no evidence of recurrence and was able to weight bare without the need of orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.

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A Case Series of Intraneural Ganglion Cyst Involving the Common Peroneal Nerve: Potential Cause for Foot Drop

International Journal of Anatomy and Research ◽

10.16965/ijar.2021.184 ◽

2021 ◽

Vol 9 (4) ◽

pp. 8189-8194

Author(s):

Naved Ahmad ◽

◽

Huma Raiyan Khan ◽

Khizer Hussain Afroze M ◽

Saifer Khan ◽

...

Keyword(s):

Peroneal Nerve ◽

Ganglion Cyst ◽

Case Series ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Intraneural Ganglion ◽

Intraneural Ganglion Cyst ◽

Medical College ◽

Ganglion Cysts ◽

Nerve Recovery

Background: Intraneural ganglion cysts (IGC) are non-neoplastic mucinous cysts that form when thick mucinous fluid accumulates in the epineurium of peripheral nerves, with the majority of cases occurring in the para-articular or articular areas. Case Presentation: The two cases of a 69-year-old man and a 59-year-old man who acquired peroneal nerve neuropathy as a result of an intraneural ganglion cyst are presented here. The L.L.R.M. Medical College Department of Orthopedics provided care for them. There was complete nerve recovery in all patients after substantial cyst wall dissection and secretion removal. Conclusion: An intraneural ganglion cyst and trauma may exacerbate nerve damage, despite the fact that it is difficult to detect the cyst before surgery. An early diagnosis and prophylactic actions are typically associated with better outcomes. KEY WORDS: Intraneural ganglion, Common peroneal nerve, Foot drop.

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Clinical outcome after decompression of intraneural peroneal ganglion cyst and its morphologic correlation to postoperative nerve ultrasound

Journal of Neurosurgery ◽

10.3171/2019.3.jns182699 ◽

2020 ◽

Vol 133 (1) ◽

pp. 233-239

Author(s):

Andreas Knoll ◽

Andrej Pal’a ◽

Maria-Teresa Pedro ◽

Ute Bäzner ◽

Max Schneider ◽

...

Keyword(s):

Clinical Outcome ◽

Peroneal Nerve ◽

Ganglion Cyst ◽

Common Peroneal Nerve ◽

Ultrasound Scan ◽

Intraneural Ganglion ◽

Nerve Ultrasound ◽

Medial Side ◽

Ganglion Cysts

OBJECTIVEIntraneural ganglion cysts are rare and benign mucinous lesions that affect peripheral nerves, most frequently the common peroneal nerve (CPN). The precise pathophysiological mechanisms of intraneural ganglion cyst development remain unclear. A well-established theory suggests the spread of mucinous fluid along the articular branch of the peroneal nerve as the underlying mechanism. Clinical outcome following decompression of intraneural ganglion cysts has been demonstrated to be excellent. The aim of this study was to evaluate the correlation between clinical outcome and ultrasound-detected morphological nerve features following decompression of intraneural ganglion cysts of the CPN.METHODSData were retrospectively analyzed from 20 patients who underwent common peroneal nerve ganglion cyst decompression surgery at the Universität Ulm/Günzburg Neurosurgery Department between October 2003 and October 2017. Postoperative clinical outcome was evaluated by assessment of the muscular strength of the anterior tibial muscle, the extensor hallucis longus muscle, and the peroneus muscle according to the Medical Research Council grading system. Hypesthesia was measured by sensation testing. In all patients, postoperative morphological assessment of the peroneal nerve was conducted between October 2016 and October 2017 using the iU22 Philips Medical ultrasound system at the last routine follow-up appointment. Finally, the correlations between morphological changes in nerve ultrasound and postoperative clinical outcomes were evaluated.RESULTSDuring the postoperative ultrasound scan an intraneural hypoechogenic ring structure located at the medial side of the peroneal nerve was detected in 15 (75%) of 20 patients, 14 of whom demonstrated an improvement in motor function. A regular intraneural fasicular structure was identified in 3 patients (15%), who also reported recovery. In 1 patient, a recurrent cyst was detected, and 1 patient showed intraneural fibrosis for which recovery did not occur in the year following the procedure. Two patients (10%) developed neuropathic pain that could not be explained by nerve ultrasound findings.CONCLUSIONSThe results of this study demonstrate significant recovery from preoperative weakness after decompression of intraneural ganglion cysts of the CPN. A favorable clinical outcome was highly correlated with an intraneural hypoechogenic ring-shaped structure on the medial side of the CPN identified during a follow-up postoperative ultrasound scan. These study results indicate the potential benefit of ultrasound scanning as a prognostic tool following decompression procedures for intraneural ganglion cysts of the CPN.

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Immediate Nerve Transfer for Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review

Plastic Surgery ◽

10.1177/2292550317747844 ◽

2018 ◽

Vol 26 (2) ◽

pp. 80-84 ◽

Cited By ~ 3

Author(s):

Imran Ratanshi ◽

Tod A. Clark ◽

Jennifer L. Giuffre

Keyword(s):

Peroneal Nerve ◽

Nerve Palsy ◽

Common Peroneal Nerve ◽

Ankle Dorsiflexion ◽

Foot Drop ◽

Peroneal Nerve Palsy ◽

Intraneural Ganglion ◽

Motor Branch ◽

Ganglion Cysts ◽

The Common

Intraneural ganglion cysts, which occur within the common peroneal nerve, are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presented with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to flexor hallucis longus to a motor branch of anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, no evidence of recurrence and was able to bear weight without the need for orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.

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