Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve

Liang, Teresa; Panu, Anukul; Crowther, Sean; Low, Gavin; Lambert, Robert G.

doi:10.1007/s11420-013-9345-9

Cited by 26 publications

(22 citation statements)

References 9 publications

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“…4). 4,7,11,51,66,70,74,75,79,81,93,98,101,103,109,113,114,128,154,156,157,170,174,176 Most of these joint connections were found in publications that provided several MR images and some were seen based on 1 or 2 published images. In another 4 cases, the findings were suggestive of joint connections to the STFJ, but no connection could be definitively confirmed given the limitations and number and quality of the available images.…”

Section: Part 2 Mri Reviewmentioning

confidence: 99%

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

Desy

Wang²,

Elshiekh

et al. 2016

JNS

113

134

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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%

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

Desy

Wang²,

Elshiekh

et al. 2016

JNS

113

134

View full text Add to dashboard Cite

show abstract

“…Some patients may present with gradual or acute weakness of the muscles located in the anterior and lateral compartments of the leg. Muscle denervation and atrophy have also been described [3,[13][14][15][16]. In our case, the patient presented with an acute painless foot drop that occurred during a military march and developed in a short period of time with no obvious history of trauma.…”

Section: Discussionmentioning

confidence: 64%

Acute Complete Foot Drop Caused by Intraneural Ganglion Cyst without a Prior Traumatic Event

Stamiris

Sarridimitriou

et al. 2020

Case Reports in Orthopedics

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Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.

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“…In addiction, a successive corticosteroid injection inside the cyst can definitely lead to pain relief and an improvement of symptoms for the anti-inflammatory property of steroids, finally decreasing the probabilities of its recurrence: Once again, the role of ultrasound guidance to guarantee the intra-lesion injection of the drug is therefore essential, to also prevent any kind of complication that might be related with soft tissues infiltration [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, ultrasound examination revealed its usefulness in identifying these lesions around the knee [1,4] showing above all the great advantage in providing an alternative nonoperative method of treating these lesions [5], consisting its application through a real-time guidance for percutaneous needle aspiration, eventually followed by a corticosteroid injection to prevent further inflammation [1,6].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case

et al. 2014

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Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.Keywords Ultrasound guidance Á Ganglion cyst Á Posterior cruciate ligament Á Steroid injection Á Knee pain Abstract Le cisti gangliari sono formazioni benigne che derivano dalla degenerazione mucinosa del tessuto connettivo ed il loro sviluppo all'interno della caività articolare del ginocchio è relativamente rara.Esse si manifestano con dolore, versamento articolare, nonché occasionalmente con gonfiore e sottoforma di una massa palpabile a livello della regione poplitea.La loro aspirazione percutanea, eventualmente seguita da un'iniezione di corticosteroide, ha una valenza sia diagnostica che terapeutica e l'ausilio della guida ecografica permette all'operatore di rendere la procedura la più accurata possibile, assicurando il corretto posizionamento dell'ago all'interno della lesione.Vogliamo riportare la nostra esperienza nel trattamento percutaneo tramite guida ecografica di una voluminosa cisti gangliare del legamento crociato posteriore in una giovane paziente sintomatica.

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Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve

Abstract: Aspiration and injection of corticosteroid is a useful and minimally invasive alternative to surgery for managing intraneural ganglion cysts.

Cited by 26 publications

References 9 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

Acute Complete Foot Drop Caused by Intraneural Ganglion Cyst without a Prior Traumatic Event

Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case

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