scholarly journals The nearly invisible intraneural cyst: a new and emerging part of the spectrum

2017 ◽  
Vol 42 (3) ◽  
pp. E10 ◽  
Author(s):  
Thomas J. Wilson ◽  
Marie-Noëlle Hébert-Blouin ◽  
Naveen S. Murthy ◽  
Joaquín J. García ◽  
Kimberly K. Amrami ◽  
...  
Keyword(s):  
Physical Examination ◽  
Ganglion Cyst ◽  
Tibialis Anterior Muscle ◽  
Common Peroneal Nerve ◽  
Imaging Findings ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Ganglion Cysts ◽  
Size And Morphology ◽  
Over Time

OBJECTIVE The authors have observed that a subset of patients referred for evaluation of peroneal neuropathy with “negative” findings on MRI of the knee have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer inspection. The objective of this study was to introduce the nearly invisible peroneal intraneural ganglion cyst and provide illustrative cases. The authors further wanted to identify clues to the presence of a nearly invisible cyst. METHODS Illustrative cases demonstrating nearly invisible peroneal intraneural ganglion cysts were retrospectively reviewed and are presented. Case history and physical examination, imaging, and intraoperative findings were reviewed for each case. The outcomes of interest were the size and configuration of peroneal intraneural ganglion cysts over time, relative to various interventions that were performed, and in relation to physical examination and electrodiagnostic findings. RESULTS The authors present a series of cases that highlight the dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly invisible cyst as a new and emerging part of the spectrum. The cases demonstrate changes in size and morphology over time of both the intraneural and extraneural compartments of these cysts. Despite “negative” MR imaging findings, nearly invisible cysts can be identified in a subset of patients. CONCLUSIONS The authors demonstrate here that peroneal intraneural ganglion cysts ride a roller coaster of change in both size and morphology over time, and they describe the nearly invisible cyst as one end of the spectrum. They identified clues to the presence of a nearly invisible cyst, including deep peroneal predominant symptoms, fluctuating symptoms, denervation changes in the tibialis anterior muscle, and abnormalities of the superior tibiofibular joint, and they correlate the subtle imaging findings to the internal fascicular topography of the common peroneal nerve. The description of the nearly invisible cyst may allow for increased recognition of this pathological entity that occurs with a spectrum of findings.

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

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.

scholarly journals Ulnar Neuropathy due to Intraneural Ganglion Cyst of the Ulnar Nerve at the Elbow

2018 ◽  
Vol 07 (03) ◽  
pp. 260-264 ◽  
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Hak-cheol Ko
Keyword(s):  
Ulnar Nerve ◽  
Elbow Joint ◽  
Glenohumeral Joint ◽  
Ganglion Cyst ◽  
Ulnar Neuropathy ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Articular Branch ◽  
Right Hand ◽  
Ganglion Cysts

AbstractIntraneural ganglion cysts are rare mucinous cyst originating within the epineurium of peripheral nerves. They occur most commonly in the peroneal nerve. However, they have also been described in many nerves in the vicinity of synovial joints. Intraneural ganglion cysts in the upper extremity are rare. Those at the elbow joint comprise only 9% of intraneural ganglion ever reported.A 66-year-old and right-handed male patient presented with a sudden onset of right-hand weakness. He initially noticed paresthesia with decreased sensation in the lateral two digits and radial palm in his right hand. Physical examination showed thenar muscle atrophy and muscle weakness of the abductor pollicis brevis in the right hand. Preoperative diagnosis of intraneural ganglion cyst was made on the basis of characteristic magnetic resonance imaging (MRI) findings. On exploration, the ulnar nerve was identified proximal to the elbow joint. Its articular branch was addressed and divided from the elbow joint.To the best of our knowledge, addressing the articular branch connecting the glenohumeral joint for the treatment of intraneural ganglion at the elbow has only been reported twice. We experienced a rare occurrence of intraneural ganglion cyst at the elbow manifesting an ulnar neuropathy. Here, we report intraoperative findings for the articular branch-connected to intraneural ganglion of the ulnar nerve at the elbow. Early diagnosis of intraneural ganglion with precise identification of the pathology and addressing the articular branch with atraumatic dissection of ganglion cyst are essential to achieve successful treatment for this rare lesion.

Tibial intraneural ganglia at the ankle and knee: incorporating the unified (articular) theory in adults and children

2011 ◽  
Vol 114 (1) ◽  
pp. 236-239 ◽  
Author(s):  
Gavin A. Davis ◽  
Ian H. Cox
Keyword(s):  
Clinical Utility ◽  
Tibial Nerve ◽  
Ganglion Cyst ◽  
Tarsal Tunnel ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Articular Branch ◽  
Ganglion Cysts ◽  
Adults And Children ◽  
Articular Theory

Object The etiology of intraneural ganglia has been debated for centuries, and only recently a unifying theory has been proposed. The incidence of tibial nerve intraneural ganglia is restricted to the occasional case report, and there are no reported cases of these lesions in children. While evidence of the unifying theory for intraneural ganglia of the common peroneal nerve is strong, there are only a few reports describing the application of the theory in the tibial nerve. In this report the authors examine tibial nerve intraneural ganglia at the ankle and knee in an adult and a child, respectively, and describe the clinical utility of incorporating the unifying (articular) theory in the management of tibial intraneural ganglia in adults and children. Methods Cases of tibial intraneural ganglion cysts were examined clinically, radiologically, operatively, and histologically to demonstrate the application of the unified (articular) theory for the development of these cysts in adults and children. Results Two patients with intraneural ganglion cysts of the tibial nerve were identified: an adult with an intraneural ganglion cyst of the tibial nerve at the tarsal tunnel and a child with an intraneural ganglion cyst of the tibial nerve at the knee. In each case, preoperative MR imaging demonstrated the intraneural cyst and its connection to the adjacent joint via the articular branch to the subtalar joint and superior tibiofibular joint. At surgery the articular branch was identified and resected, thus disconnecting the tibial nerve intraneural cyst from the joint of origin. Conclusions These cases detail the important features of intraneural ganglion cysts of the tibial nerve and document the clinical utility of incorporating the unifying (articular) theory for the surgical management of tibial intraneural ganglia in adults and children.

scholarly journals Proximal Sciatic Nerve Intraneural Ganglion Cyst

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Karin R. Swartz ◽  
Dianne Wilson ◽  
Michael Boland ◽  
Dominic B. Fee
Keyword(s):  
Magnetic Resonance Imaging ◽  
Sciatic Nerve ◽  
Peripheral Nerves ◽  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Resonance Imaging ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Ganglion Cysts ◽  
Left Buttock

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.

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

2016 ◽  
Vol 125 (3) ◽  
pp. 615-630 ◽  
Author(s):  
Nicholas M. Desy ◽  
Huan Wang ◽  
Mohanad Ahmed Ibrahim Elshiekh ◽  
Shota Tanaka ◽  
Tae Woong Choi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ganglion Cyst ◽  
Mr Images ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Ganglion Cysts ◽  
Significant Difference ◽  
Joint Connection ◽  
Cyst Recurrence ◽  
Univariate Analyses

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 of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.

scholarly journals Acute Complete Foot Drop Caused by Intraneural Ganglion Cyst without a Prior Traumatic Event

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Stavros Stamiris ◽  
Dimitrios Stamiris ◽  
Athanasios Sarridimitriou ◽  
Elissavet Anestiadou ◽  
Christos Karampalis ◽  
...  
Keyword(s):  
Traumatic Event ◽  
Ganglion Cyst ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
First Case ◽  
Peroneal Palsy ◽  
The Common

Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.

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

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.

scholarly journals Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve

2013 ◽  
Vol 9 (3) ◽  
pp. 270-274 ◽  
Author(s):  
Teresa Liang ◽  
Anukul Panu ◽  
Sean Crowther ◽  
Gavin Low ◽  
Robert Lambert
Keyword(s):  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Common Peroneal Nerve ◽  
Intraneural Ganglion ◽  
Ultrasound Guided ◽  
Intraneural Ganglion Cyst ◽  
The Common
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