Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications

Abstract

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.

Subparaneurial ganglion cysts of the fibular and tibial nerves: A new variant of intraneural ganglion cysts

“…Utilizing an existing database of all reported cases of intraneural ganglion cysts (Desy et al, ), we identified 80 reports with MR imaging data. Three reports exhibited the complex lobulated subparaneurial pattern—one in the CFN, arising from the anterior aspect of the STFJ (Fig.…”

“…A lack of consensus on the mechanism underlying cyst formation and treatment led to suboptimal outcomes and a high recurrence rate. In the past decade, since the unifying articular theory (Spinner et al, ) explained the pathogenesis of these cysts, outcomes have improved and recurrences have decreased (Desy et al, ); in addition the more prevalent use of magnetic resonance imaging (MRI) or ultrasound for diagnosis of peripheral nerve lesions has revealed intraneural ganglion cysts to be more common than previously believed.…”

Degenerative subtalar joints complicated by medial plantar intraneural cysts

“…4,[5][6][7][12][13][14] We speculate that failure to divide the jointganglion connection could be associated with a high rate of IGC recurrence. [2][3][4][9][10][11]15 The present study comprises an institutional series of IGCs involving the medial plantar nerve treated in various ways. The aim of the current study was to provide further support for the principles underlying the articular theory, and to explain the successes and failures of various treatment options.…”

Intraneural ganglion cysts of the lower limb

“…There are multiple theories regarding the formation of intraneural ganglion cysts with the articular/synovial theory being most widely accepted. According to this theory, cysts are formed from a capsular defect of an adjacent joint so that synovial fluid spreads along the epineurium of a nerve branch [19]. It is possible for cysts to arise from the proximal tibiofibular joint, to extend over the peroneal nerve to the sciatic nerve, and then to descend into the tibial nerve [7].…”

“…Excessive excision can result in nerve damage. Clipping or excision of intraarticular nerve ends can only be performed at specialized centers [19].…”