Tibial intraneural ganglia at the ankle and knee: incorporating the unified (articular) theory in adults and children

Davis, Gavin A; Cox, Ian

doi:10.3171/2010.3.jns10427

Cited by 27 publications

(22 citation statements)

References 16 publications

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“…To our knowledge, there are only 11 reported cases of pediatric peroneal intraneural ganglion cysts [2,3,12,13,14,15,16,17,18]. There are also about 18 cases of tibial intraneural ganglion cysts, and among them only 1 case is in the pediatric age group [19,21]. We think that our small case series of 4 patients is an important contribution to the current literature.…”

Section: Discussionmentioning

confidence: 92%

“…This could be related to repeated minor trauma or to a more strenuous activity. Our literature review revealed that there have been only 11 reported cases of peroneal intraneural ganglion cysts in the pediatric age group [2,3,12,13,14,15,16,17,18], and only 1 case of pediatric tibial ganglion cyst has been reported so far [19]. In this study, we present our experience with peroneal and tibial intraneural ganglion cysts treated surgically in 4 pediatric patients to determine clinical, radiological, electrophysiological and surgical features as well as the clinical outcome of this rare entity in the pediatric age group.…”

Section: Introductionmentioning

confidence: 99%

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Peroneal and Tibial Intraneural Ganglion Cysts in Children

Akçakaya

Shapira

Rochkind³

2013

Pediatr Neurosurg

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Background/Aims: Intraneural ganglion cyst is a rare and underrecognized clinical entity in the pediatric population, which may cause pain as well as motor and sensory neurological deficits. This study presents 4 pediatric patients harboring ganglion cysts involving the peroneal and tibial nerves. Methods: Data encompassing pre- and postoperative analyses of 4 pediatric patients with intraneural ganglion cyst was evaluated. Results: Out of these 4 patients, 3 had an intraneural ganglion cyst involving the peroneal nerve, and 1 patient had his tibial nerve involved. Two patients were operated for recurrent ganglion cysts with severe postoperative neurological deficits, after preceding operations in other institutions. The other 2 patients had no history of previous surgery, and they had their initial surgical treatment in our institute for primarily diagnosed ganglion cysts. With a mean follow-up of 24 months, all patients experienced pain relief. Significant improvement of motor deficits was achieved in 3 patients. No recurrences were encountered during the 24-month follow-up. Conclusion: Intraneural ganglion cysts in children can be treated with excellent outcome in experienced and dedicated centers, which specialize in peripheral nerve microsurgery.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Peroneal and Tibial Intraneural Ganglion Cysts in Children

Akçakaya

Shapira

Rochkind³

2013

Pediatr Neurosurg

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“…Various case reports have described the involvement of tibial nerve in the popliteal fossa by the INGC[7,12,36,40,46,47]. These tibial INGCs are the posterior counterpart of the peroneal INGCs and demonstrate an intraneural cyst and its connection to the adjacent joint via the articular branch to the PTF joint[40,47,48].…”

Section: Discussionmentioning

confidence: 99%

“…These tibial INGCs are the posterior counterpart of the peroneal INGCs and demonstrate an intraneural cyst and its connection to the adjacent joint via the articular branch to the PTF joint[40,47,48]. In one of our cases there was evidence of dual communication of the tibial intraneural cyst to both the knee and PTF joint through its corresponding articular branches (Figures 3-5) and further extension of cyst into the popliteus and tibialis posterior nerve branches (Figures 3-5).…”

Section: Discussionmentioning

confidence: 99%

Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?

Panwar

Mathew

Thomas

2017

WJR

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AIMTo highlight the salient magnetic resonance imaging (MRI) features of the intraneural ganglion cyst (INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extra-neural cystic lesions.METHODSA retrospective analysis of the magnetic resonance (MR) images of a cohort of 245 patients presenting with nerve palsy involving different peripheral nerves was done. MR images were analyzed for the presence of a nerve lesion, and if found, it was further characterized as solid or cystic. The serial axial, coronal and sagittal MR images of the lesions diagnosed as INGC were studied for their pattern and the anatomical extent along the course of the affected nerve and its branches. Its relation to identifiable anatomical landmarks, intra-articular communication and presence of denervation changes in the muscles supplied by involved nerve was also studied.RESULTSA total of 45 cystic lesions in the intra or extraneural locations of the nerves were identified from the 245 MR scans done for patients presenting with nerve palsy. Out of these 45 cystic lesions, 13 were diagnosed to have INGC of a peripheral nerve on MRI. The other cystic lesions included extraneural ganglion cyst, paralabral cyst impinging upon the suprascapular nerve, cystic schwannoma and nerve abscesses related to Hansen’s disease involving various peripheral nerves. Thirteen lesions of INGC were identified in 12 patients. Seven of these affected the common peroneal nerve with one patient having a bilateral involvement. Two lesions each were noted in the tibial and suprascapular nerves, and one each in the obturator and proximal sciatic nerve. An intra-articular connection along the articular branch was demonstrated in 12 out of 13 lesions. Varying stages of denervation atrophy of the supplied muscles of the affected nerves were seen in 7 cases. Out of these 13 lesions in 12 patients, 6 underwent surgery.CONCLUSIONINGC is an important cause of reversible mono-neuropathy if diagnosed early and surgically treated. Its classic MRI pattern differentiates it from other lesions of the peripheral nerve and aid in its therapeutic planning. In each case, the joint connection has to be identified preoperatively, and the same should be excised during surgery to prevent further cyst recurrence.

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“…12 An intraneural ganglion of the tibial nerve is a rare type of tarsal tunnel ganglion that originates from neighboring joints with connections to the joints through articular branches. [13][14][15] It calls for open resection and is a contraindication for endoscopic ganglionectomy (Table 1).…”

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confidence: 99%

Endoscopic Resection of the Tarsal Tunnel Ganglion

Lui¹

2016

Arthroscopy Techniques

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Abstract:The tarsal tunnel ganglion is a cause of posterior tarsal tunnel syndrome. Open resection of the ganglion calls for release of the flexor retinaculum and dissection around the tibial neurovascular bundle. This can induce fibrosis around the tibial nerve. We report the technique of endoscopic resection of the tarsal tunnel ganglion. It is indicated for tarsal tunnel ganglia arising from the adjacent joints or tendon sheaths and compressing the tibial nerve from its deep side. It is contraindicated if there is other pathology of the tarsal tunnel that demands open surgery; if the ganglion compresses the tibial nerve from its superficial side, which calls for a different endoscopic approach using the ganglion portal; or if an intraneural ganglion of the tibial nerve is present. The purpose of this technical note is to describe a minimally invasive approach for endoscopic resection of the tarsal tunnel ganglion.

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Tibial intraneural ganglia at the ankle and knee: incorporating the unified (articular) theory in adults and children

Abstract: These cases detail the important features of intraneural ganglion cysts of the tibial nerve and document the clinical utility of incorporating the unifying (articular) theory for the surgical management of tibial intraneural ganglia in adults and children.

Cited by 27 publications

References 16 publications

Peroneal and Tibial Intraneural Ganglion Cysts in Children

Peroneal and Tibial Intraneural Ganglion Cysts in Children

Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?

Endoscopic Resection of the Tarsal Tunnel Ganglion

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