Intraneural Ganglion of the Peroneal Nerve—A Rare Cause of Pediatric Peroneal Nerve Palsy: A Case Report

Abstract

Intraneural ganglia are benign mucinous cysts located within the epineurium of a peripheral nerve. The pathogenesis and formation of intraneural ganglia are controversial. The main theories described in the literature are of degenerative, synovial or de novo occurrence. We present the case of a 14-year-old boy who presented in our outpatient clinic with a complaint of interdigital neuralgia between hallux and second toe, as well as left foot drop. MRI examination showed a hyperintense cystic distension of the common peroneal nerve measuring 130 mm × 5 mm extending from the poplitea to the anterior compartment of the leg. We performed microscopic decompression and neurolysis surgery. The cyst showed a sac-like distension at its distal end with connection to the tibiofibular joint and was resected. After 8 weeks, postoperatively, the boy claimed to be pain-free and slight recovery of the superficial peroneal nerve was noticed. At 6 months postoperative, the patient showed a continuous improvement of motor function, demonstrating foot eversion with 3/5 muscle strength and foot extension with 2/5 muscle strength. Intraneural ganglia reported for pediatric patients represent a very rare entity. To the best of our knowledge, less than 15 cases have been described within the English-speaking literature.

Peroneal Nerve Injury due to Hip Surgery Located at the Knee Level: A Case Report

“…13,14 The iatrogenic causes may include surgical interventions in the lower extremity, improper positioning during general anesthesia, or application of the splints, casts, wrappings, and bandages. 14,15 The idiopathic causes may include increased anatomic risk factors and consequential CPN entrapment at the fibular tunnel, 16 or formation of an intraneural ganglion cyst, 17,18 while neoplastic etiology mostly include nerve schwannomas. 19 Surgical treatment of the CPN palsy following trauma and associated orthopedic interventions must be planned well, due to the various mechanisms of injury and different locations at which the nerve may be damaged.…”

The beauty of pediatric musculoskeletal ultrasound

“…Due to their anatomical location, neurological symptoms secondary to compression of the common peroneal nerve are commonly encountered [39]. Ganglion cysts extending within the epineurium of an articular nerve branch of the peroneal nerve (intraneural ganglia) are even rarer in children [40]. US can show the cystic nature of the lesion, identify the common peroneal nerve, and look for signs of compression or intraneural extension [40].…”

“…Ganglion cysts extending within the epineurium of an articular nerve branch of the peroneal nerve (intraneural ganglia) are even rarer in children [40]. US can show the cystic nature of the lesion, identify the common peroneal nerve, and look for signs of compression or intraneural extension [40]. MRI may better delineate the size and location of the cyst as well as the possible interosseous extension [39,40].…”

“…US can show the cystic nature of the lesion, identify the common peroneal nerve, and look for signs of compression or intraneural extension [40]. MRI may better delineate the size and location of the cyst as well as the possible interosseous extension [39,40].…”

Recurrent Peroneal Intraneural Ganglion Cyst: Management and Review of the Literature

“…Peroneal intraneural ganglion cysts present with motor deficits and peripheral neuropathy, manifesting as a foot drop with a high stepping gait and associated sensory deficits [ 5 ]. The first-line treatment for peroneal intraneural ganglion cysts is surgical intervention, usually surgical exploration, decompression of the peroneal nerve, drainage of the cyst, and obliteration of the small sensory nerve to the tibiofibular (TF) joint [ 6 ].…”