The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

Spinner, Robert J.; Mokhtarzadeh, Ali; Schiefer, Terry K.; Krishnan, Kartik G.; Kliot, Michel; Amrami, Kimberly K.

doi:10.1007/s00256-006-0213-2

Cited by 68 publications

(75 citation statements)

References 25 publications

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“…Eleven of these cases and our reinterpretations were published. 115,116,120,124,136,143,144,147,153 The MR image reviews were all done by a fellowshiptrained musculoskeletal radiologist and the senior author, a neurosurgeon, both highly experienced in evaluating intraneural ganglion cysts.…”

Section: Part 2 Mri Reviewmentioning

confidence: 99%

“…63 Furthermore, of the 16 cases in which we were able to obtain the original full MRI series of select cases, 18,22,99,100,109,115,116,120,124,136,143,144,147,153 all had previously unrecognized joint connections: ulnohumeral joint (1), carpal joint (1), acetabulofemoral joint (3), tibiofemoral joint (4), STFJ (6), and tibiotalar joint (1) (Fig. 5).…”

Section: Part 2 Mri Reviewmentioning

confidence: 99%

“…124,125 Since then, the articular (synovial) theory has been further substantiated by our group and others at many other nerves at several other anatomical locations. 13,19,82,102,113,114,117,118,135,143,144,147,153,170,173 Three principles for these cysts have emerged: 1) intraneural ganglion cysts are formed from a capsular defect of a neighboring joint, which allows joint fluid to egress and track along the epineurium of an innervating articular branch; 2) the fluid follows the path of least resistance; and 3) the cyst takes form due to changes in pressure and pressure fluxes.…”

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confidence: 99%

“…As shown in our cases and others, many joints associated with intraneural cysts are degenerative. 69,83,86,[88][89][90]107,124,141,147,149,160,161,175 Trauma, which was identified in 13% of patients, has also been found to play a role in intraneural ganglion cyst formation. Either direct articular trauma 17 or an indirect mechanism of injury, such as a torsional load applied away from the joint can cause a capsular defect that permits cyst fluid extravasation.…”

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confidence: 99%

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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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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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Section: Part 2 Mri Reviewmentioning

confidence: 99%

Section: Part 2 Mri Reviewmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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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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134

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“…Different theories, without a scientific basis, have been proposed. 4,[6][7][8]15,19,20,24,27 The articular (synovial) theory, 42,45 based on robust clinical, imaging, and histological evidence, 11,[39][40][41][42]44,45,47,49,50 provides a logical, consistent explanation that clarifies and unifies the observations made by many over the years. Developed on the prototype of the peroneal nerve ganglion cysts, the theory can be extrapolated to intraneural ganglion cysts involving other nerves.…”

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

Elangovan

Odegard

Morrow

et al. 2009

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Intraneural ganglion cysts have been considered a curiosity for 2 centuries. Based on a unifying articular (synovial) theory, recent evidence has provided a logical explanation for their formation and propagation. The fundamental principle is that of a joint origin and a capsular defect through which synovial fluid escapes following the articular branch, typically into the parent nerve. A stereotypical, reproducible appearance has been characterized that suggests a shared pathogenesis. In the present report the authors will provide a mechanistic explanation that can then be mathematically tested using a preliminary model created by finite element analysis.

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

et al. 2007

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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.

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The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

Cited by 68 publications

References 25 publications

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

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

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

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

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