Intraneural ganglia: a clinical problem deserving a mechanistic explanation and model

Elangovan, Shreehari; Odegard, Gregory M.; Morrow, Duane A.; Wang, Huan; Hébert-Blouin, Marie Noëlle; Spinner, Robert J.

doi:10.3171/foc.2009.26.2.e11

Cited by 23 publications

(16 citation statements)

References 46 publications

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“…Intraneural propagation within the epineurium occurs following the path of least resistance. 22 Just as in the lower extremity where extensive longitudinal dissection of cyst may occur (for example, buttock level extension of a peroneal nerve 30,95 ) we identified a similar situation where an ulnar nerve cyst propagated from the cubital tunnel to the infraclavicular brachial plexus. 17 A suprascapular intraneural ganglia arising from the glenohumeral joint extended to the neck.…”

Section: Fundamental Principlesmentioning

confidence: 83%

Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory

Wang

Terrill

Tanaka³

et al. 2009

FOC

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Object Intraneural ganglia are nonneoplastic mucinous cysts contained within the epineurium of peripheral nerves. Their pathogenesis has been controversial. Historically, the majority of authors have favored de novo formation (degenerative theory). Because of their rarity, intraneural ganglia affecting the upper limb have been misunderstood. This study was designed to critically analyze the literature and to test the hypothesis that intraneural ganglia of the upper limb act analogously to those in the lower limb, being derived from an articular source (synovial theory). Methods Two patients with digital intraneural cysts were included in the study. An extensive literature review of intraneural ganglia of the upper limb was undertaken to provide the historical basis for the study. Results In both cases, the digital intraneural ganglia were demonstrated to have joint connections; the one patient in whom an articular branch was not appreciated initially had evidence on postoperative MR images of persistence of intraneural cyst after simple decompression was performed. Eighty-six cases of intraneural lesions were identified in varied locations of the upper limb: the most common sites were the ulnar nerve at the elbow and wrist, occurring 38 and 22 times, respectively. Joint connections were present in only 20% of the cases published by other groups. Conclusions The authors believe that the fundamental principles of the unifying articular (synovial) theory (that is, articular branch connections, cyst fluid following a path of least resistance, and the role of pressure fluxes) previously described to explain intraneural ganglia in the lower limb apply to those cases in the upper limb. In their opinion, the joint connection is often not identified because of the cysts' rarity, radiologists' and surgeons' inexperience, and the difficulty visualizing and demonstrating it because of the small size of the cysts. Furthermore, they believe that recurrence (subclinical or clinical) is not only underreported but also predictable after simple decompression that fails to address the articular branch. In contrast, intraneural recurrence can be eliminated with disconnection of the articular branch.

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Section: Fundamental Principlesmentioning

confidence: 83%

Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory

Wang

Terrill

Tanaka³

et al. 2009

FOC

Self Cite

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“…The tumoral theory, least favored of the three, compares an intraneural ganglion to other cystic lesions or tumors and hypothesizes that even an organized hematoma can transform into an intraneural ganglion cyst. Recent advances in imaging, histological investigation, and mathematical analysis [3] point to the unifying synovial (articular) theory as being the most logical and applicable explanation of intraneural ganglion origin.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Intraneural Ganglion Cyst of the Ulnar Nerve at the Wrist

Colbert

2011

Hand (New York, N,Y.)

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We report a case of a 69-year-old male who presented with pain, weakness, and clumsiness of his right hand. Initial evaluation suggested possible neoplastic process affecting his cervical spine, which was fortunately ruled out by bone biopsy. Subsequent electrodiagnostic studies and magnetic resonance imaging confirmed a lesion of the deep ulnar motor branch. Exploration of Guyon's canal was performed, and an intraneural ganglion involving the deep motor branch of the ulnar nerve was found and excised. Despite more than 14 months of symptomatic duration, the patient made a near-complete recovery with virtually no functional limitations. This provides supporting evidence for a functional benefit of intraneural ganglion excision and nerve decompression even in cases of chronic muscle atrophy.

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“…Diagnosis of moyamoya syndrome has been defined based on cases that meet any two of these criteria. Conventional angiography remains the gold-standard imaging technique for evaluation of radiographic moyamoya; however, recent advances in MR angiography are sufficient in specific cases (Burke et al, 2009). While this disease has been reported worldwide, the estimates of incidence in the United States have been limited (Goto and Yonekawa, 1992; Edwards-Brown and Quets, 1997; Graham and Matoba, 1997; Numaguchi et al, 1997; Uchino et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Characterization of Inpatient Moyamoya in the United States: 1988–2004

Lee

Liebeskind

2011

Front. Neur.

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Background and Purpose: Moyamoya disease has been classically described by the Asian experience, yet clinical aspects of moyamoya phenomena in the United States remain vastly undefined. The multifocal occlusive arterial disorder may be linked with numerous conditions; however, later stages of this syndrome share common vascular pathophysiology. This study is aimed at characterizing inpatient moyamoya cases in the United States over a broad time span. Methods: A comprehensive analysis of the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (Releases 1–13, 1988–2004) based on ICD-9-CM code 437.5 was performed. Annual percentages and trends analyses were conducted for demographic variables, admission characteristics, co-morbidities, and procedures. Result: 2247 admissions of moyamoya cases were analyzed from a wide geographic distribution throughout the United States between 1988 and 2004. Age at admission varied considerably (mean 29.6 ± 18.5 years), affecting women more frequently than men (61.9%). Various racial groups were identified (35.4% White, 19.7% African American, 5.6% Hispanic, 8.3% Asian or Pacific Islander, 1.4% Native American). Admissions were typically emergent (38.8%) or urgent (18.7%), although elective admissions occurred (24.4%). Aside from moyamoya, sickle cell disease was diagnosed in 13.6%, ischemic stroke in 20.7%, intracerebral hemorrhage in 7.4%, transient ischemic attack in 3.4%, and subarachnoid hemorrhage in 3.1%. Cerebral angiography was performed in 24.9% while extracranial–intracranial bypass was done in 8.4% of patients. Conclusion: Moyamoya in the United States is a heterogeneous condition affecting individuals of all ages across a diverse racial spectrum and wide geographic distribution. Further recognition of moyamoya syndrome may facilitate ongoing research and future therapeutic approaches.

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Intraneural ganglia: a clinical problem deserving a mechanistic explanation and model

Cited by 23 publications

References 46 publications

Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory

Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory

Case Report: Intraneural Ganglion Cyst of the Ulnar Nerve at the Wrist

Characterization of Inpatient Moyamoya in the United States: 1988–2004

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