Intraneural ganglion of the sciatic nerve: detection by ultrasound.

Lang, C; Neubauer, U.; Qaiyumi, S. A. A.; Fahlbusch, R

doi:10.1136/jnnp.57.7.870-a

Cited by 34 publications

(22 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite prior reports of so-called ''sciatic intraneural ganglia'' (Lang et al, 1994;Krishnan and Schackert, 2003), it seems obvious to us that such ganglion cysts represent proximal extensions of fibular or tibial examples derived from the superior tibiofibular joint and follow an articular branch rather than de novo formation within the sciatic nerve. We further proved our hypothesis (Spinner et al, 2007a) by reanalyzing MR images in one of these published cases (Krishnan and Schackert, 2003), in which we succeeded in showing that a tibial intraneural ganglion cyst extending into the sciatic nerve arose from the superior tibiofibular joint.…”

Section: Discussionmentioning

confidence: 91%

Epineurial compartments and their role in intraneural ganglion cyst propagation: An experimental study

et al. 2007

View full text Add to dashboard Cite

New patterns of intraneural ganglion cyst formation are emerging that have not previously been explained in current pathoanatomic terms. We believe there are three important elements underlying the appearance of these cysts: (a) an articular branch of the nerve that connects to a nearby synovial joint; (b) ejected synovial fluid following the path of least resistance along tissue planes; and (c) the additional effects of pressure and pressure fluxes. The dynamic nature of cyst formation has become clearly apparent to us in our clinical, operative and pathologic practice, but the precise mechanism underlying the process has not been critically studied. To test our hypothesis that a fibular (peroneal) or tibial intraneural cyst derived from the superior tibiofibular joint could ascend proximally into the sciatic nerve, expand within it and descend into terminal branches of this major nerve, we designed a series of simple, qualitative laboratory experiments in two cadavers (four specimens, six experiments). Injecting dye into the outer or "epifascicular" epineurium of the fibular and the tibial nerves we observed its ascent, cross over and descent patterns in three of three specimens as well as its cross over after an outer epineurial sciatic injection. In contrast, injecting dye into the inner or "interfascicular" epineurium led to its ascent within the tibial nerve and its division within the sciatic nerve in one specimen and lack of cross over in a sciatic nerve injection. Histologic cross-sections of the nerves at varying levels demonstrated a tract of disruption within the outer epineurium of the nerve injected and the nerve(s) into which the dye, after cross over, descended. Those specimens injected in the inner epineurium demonstrated dye within this tract but without disruption of or dye intrusion into the outer epineurium. In no case did the dye pass through the perineurial layers. Coupled with our observations in previous detailed studies, these anatomic findings provide proof of concept that sciatic cross over occurs due to the filling of its common epineurial sheath; furthermore, these findings, support the unifying articular theory, even in cases wherein patterns of intraneural ganglion cyst formation are unusual. Additional work is needed to be done to correlate these anatomic findings with magnetic resonance imaging and surgical pathology.

show abstract

Section: Discussionmentioning

confidence: 91%

Epineurial compartments and their role in intraneural ganglion cyst propagation: An experimental study

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Sonography shows a typical ganglion ( Figure 9): a usually welldefined, encapsulated, multiloculated mass that is anechoic or contains scanty low-level echoes and that shows distal acoustic enhancement. [17][18][19] Nerve fibers may be splayed around the mass. In my experience, approximately half the cases of ganglia affecting the common peroneal nerve resolve spontaneously, without surgery.…”

Section: Intraneural Ganglionmentioning

confidence: 98%

Sonographic appearances of nerve tumors

Beggs

1999

J. Clin. Ultrasound

122

View full text Add to dashboard Cite

“…Ultrasound (Prevot et al, 1990;Leitjen et al, 1992;Lang et al, 1994;Dubuisson and Stevenaert, 1996;Aulisa et al, 1998) and CT (Firooznia et al, 1983;Pazzaglia, et al, 1989;Gambari et al, 1990;Antonini et al, 1991) have both been used in an attempt to characterize these cysts and their origins but have fallen short when compared to optimized MRI techniques and the superior soft-tissue contrast and high spatial resolution (Leon and Marano, 1987;Coakley et al, 1995;Kuntz et al, 1996;Uetani et al, 1998;Grant et al, 2004). Even MRI, however, may not be adequate to demonstrate joint connections, if optimized techniques are not used.…”

Section: Discussionmentioning

confidence: 97%

Application of three-dimensional rendering in joint-related ganglion cysts

2006

View full text Add to dashboard Cite

The origin of para-articular cysts is poorly understood and controversial. The relatively common, simple (extraneural) cysts are presumed to be derived from joints, although joint connections are not always established. Rarer complex cysts are thought by many to form de novo within nerves (intraneural ganglion cysts) or within vessels (adventitial cysts) (degenerative theory). We believe that these simple and complex ganglion cysts are joint-related (articular theory). Joint connections are often not readily appreciated with routine imaging or at surgery. Not identifying and/or treating joint connections frequently leads to cyst recurrence. More sophisticated imaging may enhance visualization of these joint connections. We created a 3D rendering technique to assess potential joint connections of simple and complex cysts localized to the knee and superior tibiofibular joints in patients with fibular (peroneal) neuropathy. Two- and three-dimensional data sets from MRI examinations were segmented semiautomatically by signal intensity with further refinement based on interaction with the user to identify specific anatomic structures, such as small nerves and vessels on serial images. The bone, cysts, nerves, and vessels were each assigned different color representations, and 3D renderings were created in ANALYZE using the data sets closest to isotropic (voxel with equal length in all dimensions) resolution as the primary background rendering. We selected four cases to illustrate the spectrum of pathology. In all of these cases, we demonstrated joint connections and correlated imaging and operative findings. Surgery addressing the cyst and the joint connection resulted in excellent outcomes; postoperative MRIs done more than 6 months later confirmed that there was no recurrence. In addition to highlighting the important relationship of these cysts to neighboring anatomic structures, this 3D technique allows visualization of "occult" connections not readily appreciated with standard MR imaging. We believe that these joint-related cysts have a common pathogenesis; they dissect through a capsular rent and follow the path of least resistance; they may form simple cysts by dissecting out into the soft tissue, or more complex cysts by dissecting within the epineurium of nerves or adventitia of vessels (along an articular branch), or various combinations of all of these types of cysts. Understanding the pathogenesis for cyst formation will improve surgical management and outcomes. We have adapted this 3D technique to enhance the visualization of cysts occurring at other joints.

show abstract

Intraneural ganglion of the sciatic nerve: detection by ultrasound.

Cited by 34 publications

References 4 publications

Epineurial compartments and their role in intraneural ganglion cyst propagation: An experimental study

Epineurial compartments and their role in intraneural ganglion cyst propagation: An experimental study

Sonographic appearances of nerve tumors

Application of three-dimensional rendering in joint-related ganglion cysts

Contact Info

Product

Resources

About