Recurrent ganglion cyst of the peroneal nerve: radiological and operative observations

1996 ◽  
Vol 84 (2) ◽  
pp. 280-283 ◽  
Author(s):  
Annie S. Dubuisson ◽  
Achille Stevenaert
Keyword(s):  
Mr Imaging ◽  
Knee Joint ◽  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Close Contact ◽  
Foot Drop ◽  
Leg Pain ◽  
Content Type ◽  
Tibiofibular Joint ◽  
Fine Print

✓ This 34-year-old man presented with right leg pain and foot drop of 1-month duration. The preoperative diagnosis of a 10-cm-long ganglion cyst of the peroneal nerve was achieved using ultrasonography (US), computerized tomography and, particularly magnetic resonance (MR) imaging. Surgical exploration disclosed a lobulated cystic mass filled with gelatinous material, which intermingled with the nerve substance of the deep peroneal nerve. The lesion was completely resected, with the sacrifice of some electrically nonfunctioning fascicles. No connection with the knee joint was found. A good postoperative recovery of motor function was obtained. However, routine postoperative MR imaging disclosed a recurrent ganglion cyst that was slightly less extensive than the original. A careful radiological examination of the knee joint was performed, including arthrography. A communication of the cyst with the tibiofibular joint was clearly demonstrated and was meticulously closed at reoperation. The patient's postoperative course was uneventful, and a third MR image, obtained 5 months after reoperation, showed no sign of cyst recurrence. The patient remained free of symptoms 11 months postoperatively. This case illustrates the value of US and MR in diagnostic imaging. The diagnostic efficacy of US and MR imaging in identifying and characterizing a ganglion cyst is described. Close contact between a ganglion cyst and the tibiofibular joint should raise the possibility of an existing cyst—joint communication and lead to an aggressive radiological workup and/or a surgical search for such a communication.

Superficial peroneal nerve entrapment

1981 ◽  
Vol 55 (6) ◽  
pp. 991-992 ◽  
Author(s):  
Timir Banerjee ◽  
Dexter D. Koons
Keyword(s):  
Differential Diagnosis ◽  
Peroneal Nerve ◽  
Nerve Entrapment ◽  
Leg Pain ◽  
Superficial Peroneal Nerve ◽  
Content Type ◽  
Fine Print

✓ Two cases of entrapment of the superficial peroneal nerve are presented. This is an unusual cause for leg discomfort and should be considered in the differential diagnosis of leg pain.

Ultrasound diagnosis of an intraneural ganglion cyst of the peroneal nerve

1992 ◽  
Vol 76 (3) ◽  
pp. 538-540 ◽  
Author(s):  
Frans S. S. Leijten ◽  
Willem-Frans Arts ◽  
Julien B. C. M. Puylaert
Keyword(s):  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Ultrasound Diagnosis ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
Content Type ◽  
Definition Of ◽  
Exact Definition ◽  
Fine Print

✓ The authors present the case of an intraneural ganglion cyst of the peroneal nerve. The cyst was diagnosed by means of ultrasound, which also gave an exact definition of its size and location, confirmed at operation. Some controversial aspects of these lesions are discussed.

Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory

2003 ◽  
Vol 99 (2) ◽  
pp. 330-343 ◽  
Author(s):  
Robert J. Spinner ◽  
John L. D. Atkinson ◽  
Robert L. Tiel
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Clinical Results ◽  
Articular Branch ◽  
Content Type ◽  
Superior Tibiofibular Joint ◽  
Imaging Characteristics ◽  
Objective Evidence ◽  
Tibiofibular Joint ◽  
Fine Print

Object. Based on a large multicenter experience and a review of the literature, the authors propose a unifying theory to explain an articular origin of peroneal intraneural ganglia. They believe that this unifying theory explains certain intriguing, but poorly understood findings in the literature, including the proximity of the cyst to the joint, the unusual preferential deep peroneal nerve (DPN) deficit, the absence of a pure superficial peroneal nerve (SPN) involvement, the finding of a pedicle in 40% of cases, and the high (10–20%) recurrence rate. Methods. The authors believe that peroneal intraneural lesions are derived from the superior tibiofibular joint and communicate from it via a one-way valve. Given access to the articular branch, the cyst typically dissects proximally by the path of least resistance within the epineurium and up the DPN and the DPN component of the common peroneal nerve (CPN) before compressing nearby SPN fascicles. The authors present objective evidence based on anatomical, clinical, imaging, operative, and histological data that support this unifying theory. Conclusions. The predictable clinical presentation, electrical studies, imaging characteristics, operative observations, and histological findings regarding peroneal intraneural ganglia can be understood in terms of their origin from the superior tibiofibular joint, the anatomy of the articular branch, and the internal topography of the peroneal nerve that the cyst invades. Understanding the controversial pathogenesis of these cysts will enable surgeons to perform operations based on the pathoanatomy of the articular branch of the CPN and the superior tibiofibular joint, which will ultimately improve clinical results.

Peroneal intraneural ganglia: the importance of the articular branch. Clinical series

2003 ◽  
Vol 99 (2) ◽  
pp. 319-329 ◽  
Author(s):  
Robert J. Spinner ◽  
John L. D. Atkinson ◽  
Bernd W. Scheithauer ◽  
Michael G. Rock ◽  
Rolfe Birch ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Articular Branch ◽  
Content Type ◽  
Superior Tibiofibular Joint ◽  
Imaging Characteristics ◽  
Clinical Series ◽  
Tibiofibular Joint ◽  
Fine Print

Object. The peroneal nerve is the most common site of intraneural ganglia. The neurological deficit associated with these cysts is often severe and the operation to eradicate them is difficult. The aims of this multicenter study were to collate the authors' experience with a relatively rare lesion and to improve clinical outcomes by better understanding its controversial pathogenesis. Methods. Part I of this paper offers a description of 24 patients with peroneal intraneural ganglia who were treated by surgeons aware of the importance of the peroneal nerve's articular branch. Part II offers a description of three more patients who were seen after earlier operations in which the ganglion was excised, but the articular branch was not identified (all reportedly gross-total resections). Twenty-six of the 27 patients presented with clinical, electrophysiological, and imaging evidence of a common peroneal nerve (CPN) lesion, predominantly affecting the deep peroneal nerve (DPN) division, and one patient presented with a painful mass of the CPN that was not accompanied by a neurological deficit. In all 24 patients in Part I there was magnetic resonance (MR) imaging evidence of a connection between the cyst and the superior tibiofibular joint, including one patient in whom high-resolution (3-tesla) MR neurography demonstrated the pathological articular branch itself. At the operation, the communication proved to extend through the articular branch of the CPN in all cases. The operation consisted of drainage of the cyst and ligation of the articular branch. At a minimum follow-up period of 1 year, these patients experienced significant improvements in their neuropathic pain, but only mild improvements in their functional deficits. In none of the 24 patients was there evidence of an intraneural recurrence. In three patients, however, extraneural ganglia developed: two patients with symptoms subsequently underwent resection of the superior tibiofibular joint without further recurrence and one patient with no symptoms was followed clinically after the recurrence was detected incidentally on 1-year postoperative imaging. As predicted, in Part II all three patients in whom the articular branch had not been ligated experienced early intraneural recurrence; both postoperative MR images and original studies, which were retrospectively examined, demonstrated a connection with the superior tibiofibular joint. Conclusions. The clinical presentation, electrical studies, imaging characteristics, and operative observations regarding peroneal intraneural ganglia are predictable. Treatment must address the underlying pathoanatomy and should include decompression of the cyst and ligation of the articular branch of the nerve. To avoid extraneural recurrence, resection of the superior tibiofibular joint may also be necessary, but indications for this additional procedure need to be defined. These recommendations are based on the authors' belief that intraneural peroneal ganglia arise from the superior tibiofibular joint and are connected to it by the articular branch.

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

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.

Peripheral nerve entrapment due to steroid-induced lipomatosis of the popliteal fossa

1986 ◽  
Vol 64 (4) ◽  
pp. 666-668 ◽  
Author(s):  
Charles E. Rawlings ◽  
Dennis E. Bullard ◽  
David S. Caldwell
Keyword(s):  
Peripheral Nerve ◽  
Peroneal Nerve ◽  
Complete Recovery ◽  
Popliteal Fossa ◽  
Nerve Entrapment ◽  
Foot Drop ◽  
Content Type ◽  
Fine Print

✓ A case of peroneal nerve entrapment is reported in a patient with scleroderma. Compression was due to a lipoma in the popliteal fossa and resulted in increasingly severe foot-drop. Complete recovery occurred after the lipoma was resected. A brief review of peroneal nerve palsies and lipomatosis is presented.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

Thalamic lesions produced by gamma thalamotomy for movement disorders

2002 ◽  
Vol 97 ◽  
pp. 600-606 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Jie Zhang ◽  
Yoshitaka Andou
Keyword(s):  
Mr Imaging ◽  
Involuntary Movement ◽  
Gamma Knife Radiosurgery ◽  
Target Point ◽  
High Signal ◽  
Thalamic Lesion ◽  
Content Type ◽  
Stereotactic Thalamotomy ◽  
Thalamic Lesions ◽  
Fine Print

Object. The treatment of Parkinson disease and other kinds of involuntary movement by gamma knife radiosurgery (GKS) is presented. This is an extension of previous work. The clinical course and thalamic lesions were the main factors examined. Methods. Seventeen new cases were added to the previously reported 36 cases. The course and results for the whole series of 53 patients were examined. Treatment was undertaken using a single 4-mm collimator shot to deliver 130 Gy to the target. The target was determined in the previously treated patients by using classic methods involved in conventional stereotactic thalamotomy with microrecording. More recently, target localization has been performed by relating the target point to the total length of the thalamus. Points may then be defined as percentages of that length measured from the anterior pole. Targets can then be determined in relationship to the appropriate percentage. Thirty-five patients have been followed for more than 2 years and the longest follow up was 8 years. Two kinds of thalamic lesion were seen after GKS. Volumetric analysis on MR imaging revealed that the larger lesion was 400 to 500 mm3 at the beginning and gradually decreased in size. The smaller lesion occupied approximately 200 mm3 and also shrank over several months. Eighty percent of the treated cases showed good results and no significant complications, with the tremor subsiding at 1 year (Type 1). Several cases deviated from this standard course in four different ways (Types 2–5). If tremor persisted, conventional stereotactic thalamotomy with microrecording was performed. During such operations, normal neuronal activity was recorded from the region adjacent to the GKS thalamotomy target. This was the region showing a high signal on MR imaging. The activity patterns included the rhythmical grouped discharge of tremor rhythm. Conclusions. Gamma thalamotomy for functional disorders is still under development, but because the results with careful target planning are satisfactory, there are grounds for increasing optimism.

Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 87-97 ◽  
Author(s):  
Wen-Yuh Chung ◽  
Kang-Du Liu ◽  
Cheng-Ying Shiau ◽  
Hsiu-Mei Wu ◽  
Ling-Wei Wang ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Tumor Volume ◽  
Radiation Effect ◽  
Gamma Knife Surgery ◽  
Homogeneous Distribution ◽  
Content Type ◽  
Fine Print

Object. The authors conducted a study to determine the optimal radiation dose for vestibular schwannoma (VS) and to examine the histopathology in cases of treatment failure for better understanding of the effects of irradiation. Methods. A retrospective study was performed of 195 patients with VS; there were 113 female and 82 male patients whose mean age was 51 years (range 11–82 years). Seventy-two patients (37%) had undergone partial or total excision of their tumor prior to gamma knife surgery (GKS). The mean tumor volume was 4.1 cm3 (range 0.04–23.1 cm3). Multiisocenter dose planning placed a prescription dose of 11 to 18.2 Gy on the 50 to 94% isodose located at the tumor margin. Clinical and magnetic resonance (MR) imaging follow-up evaluations were performed every 6 months. A loss of central enhancement was demonstrated on MR imaging in 69.5% of the patients. At the latest MR imaging assessment decreased or stable tumor volume was demonstrated in 93.6% of the patients. During a median follow-up period of 31 months resection was avoided in 96.8% of cases. Uncontrolled tumor swelling was noted in five patients at 3.5, 17, 24, 33, and 62 months after GKS, respectively. Twelve of 20 patients retained serviceable hearing. Two patients experienced a temporary facial palsy. Two patients developed a new trigeminal neuralgia. There was no treatment-related death. Histopathological examination of specimens in three cases (one at 62 months after GKS) revealed a long-lasting radiation effect on vessels inside the tumor. Conclusions. Radiosurgery had a long-term radiation effect on VSs for up to 5 years. A margin 12-Gy dose with homogeneous distribution is effective in preventing tumor progression, while posing no serious threat to normal cranial nerve function.

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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