Intraneural Ganglion as the Cause of Compression-Ischemic Lesion of Peroneal Nerve in Children

Merkulov, V. N.; Imyarov, Sh. D; Dorokhin, A. I.

doi:10.32414/0869-8678-2014-3-76-80

Cited by 2 publications

(6 citation statements)

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“…Persistent joint connections were identified in five of these six recurrent cases following ligation/disconnection of the articular branch during primary surgery (Bäzner et al, ; Blitz et al, ; Merkulov et al, ). Four were discovered again at revision surgery (Bäzner et al, ; Merkulov et al, ) and one was seen on follow‐up MRI in a patient who did not have revision surgery (Blitz et al, ). The one patient with cyst persistence in the parent nerve following articular branch disconnection also did not receive revision surgery as the symptoms and signs had nearly completely resolved (Muramatsu et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, a total of 78 cases that had at least one intraneural recurrence (11%) were identified and included in this study (Table ): six involving nerves of the upper limbs and 72 in lower limbs with the CFN having the most absolute number of recurrences (Fig. ) (Wadstein, ; Brooks, ; Grassi and Morganti, ; Parkes, ; Ahn et al, ; Assmus et al, ; Lagarrigue et al, ; Allieu et al, ; Acciarri et al, ; Inobe et al, ; Nagano et al, ; Kuntz et al, ; Harbaugh et al, ; Patel et al, ; Piton et al, ; Nakata et al, ; Yoshihara et al, ; Spinner et al, 2000, 2006a,b, 2007a,b,d, 2008a, 2009, 2010a,b, 2011a; Chick et al, ; Drábek et al ; Suh, ; Kim et al, ; Rezzouk and Durandeau, ; Rein et al, ; Rosson et al, ; Hahn et al, ; Visser, ; Yoneyama et al, ; Gyula et al, ; Bäzner et al ; Blitz et al, , ; Araki et al, ; Wang et al, ; Ikeda and Osamura, ; Kong et al, ; Weyns et al, ; Lee et al, ; Muramatsu et al, ; Akcakaya et al 2014; Janeczko et al, ; Merkulov et al, ; Squires et al, ; Lipinski et al, 2015; Prasad et al, 2015; Sobol and Lipschultz, ). These recurrences followed a range of operations (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…In cases where the primary surgery also consisted of ligation or disconnection of the articular branch led to a 6% recurrence/persistence rate (6 out of 106 cases) (Table ) (Bäzner et al, ; Blitz et al, ; Muramatsu et al, ; Merkulov et al, ). Only three of these six cases provided imaging or a description of the recurrent cyst that allowed us to determine location and pattern.…”

Section: Resultsmentioning

confidence: 99%

“…This mechanism of extraparental (not intraparental) intraneural recurrence has been described in a sural intraneural cyst arising from the subtalar joint (Blitz et al, ). We believe that the remnant cyst with a persistent joint connection in four other cases represents a blind stump where cyst can assume a new pathway but not to the parent nerve (Bäzner et al, ; Merkulov et al, ). B: Disconnection of the wrong branch instead of the articular branch Anecdotal reports have suggested this mechanism. The cystic articular branch is not always obvious and may be small or seemingly occult.…”

Section: Discussionmentioning

confidence: 99%

“…Persistent joint connections were identified in five of these six recurrent cases following ligation/disconnection of the articular branch during primary surgery (B € azner et al, 2008;Blitz et al, 2008;Merkulov et al, 2014). Four were discovered again at revision surgery (B € azner et al, 2008;Merkulov et al, 2014) and one was seen on follow-up MRI in a patient who did not have revision surgery (Blitz et al, 2008).…”

Section: Location and Pattern Of Recurrencesmentioning

confidence: 96%

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Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

et al. 2015

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The etiology of intraneural ganglion cysts has been poorly understood. This has resulted in the development of multiple surgical treatment strategies and a high recurrence rate. We sought to analyze these recurrences in order to provide a pathoanatomic explanation and staging classification for intraneural cyst recurrence. An expanded literature search was performed to identify frequencies and patterns in cases of intraneural ganglion cyst recurrences following primary surgery. Two univariate analyses were completed to identify associations between the type of revision surgery and repeat cyst recurrences. The expanded literature search found an 11% recurrence rate following primary surgery, including 64 recurrences following isolated cyst decompression (Group 1); six after articular branch resection (Group 2); and none following surgical procedures that addressed the joint (Group 3). Eight cases did not specify the type of primary surgery. In group 1, forty-eight of the recurrences (75%) were in the parent nerve, three involved only the articular branch, and one travelled along the articular branch in a different distal direction without involving the main parent nerve. In group 2, only one case (17%) recurred/persisted within the parent nerve, one recurred within a persistent articular branch, and one formed within a persistent articular branch and travelled in a different distal direction. Intraneural recurrences most commonly occur following surgical procedures that only target the main parent nerve. We provide proven or theoretical explanations for all identified cases of intraneural recurrences for an occult or persistent articular branch pathway.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Location and Pattern Of Recurrencesmentioning

confidence: 96%

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Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

et al. 2015

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

Desy

Wang²,

Elshiekh

et al. 2016

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113

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615 Literature review J Neurosurg 125:615-630, 2016I ntraneural ganglion cysts are benign mucinous lesions that are formed within peripheral nerves and typically lead to symptoms and signs of peripheral neuropathy. Their pathogenesis has been controversial. Different treatments have been recommended. Outcomes have been disappointing and the recurrence rate high and underreported.Over the past 15 years, our group has provided substantial evidence to support a unifying articular (synovial) theory as the etiology for all intraneural ganglion cysts. In 2003, the senior author (R.J.S.) demonstrated that the prototypical intraneural cysts of the common peroneal nerve are joint derived. Cyst formation originates in the superior tibiofibular joint (STFJ) and propagates toward abbreviatioNs EMG = electromyography; NCS = nerve conduction studies; STFJ = superior tibiofibular joint. 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 o...

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Intraneural Ganglion as the Cause of Compression-Ischemic Lesion of Peroneal Nerve in Children

Cited by 2 publications

References 6 publications

Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

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

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