Ultrasound-guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve

Jose, Jean; Fourzali, Roberto; Lesniak, Bryson P.; Kaplan, Lee D.

doi:10.1007/s00256-011-1209-0

Cited by 26 publications

(35 citation statements)

References 25 publications

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“…Th e fi rst case of intraneural ganglion cyst of the tibial nerve was described in 1967. Since then, about 15 cases have been reported (1)(2)(3).…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound-guided aspiration can be performed after taking careful measures to avoid injuring the adjacent popliteal artery and the nerve fascicles. However, long-term follow-up studies are needed to determine cyst recurrence (2). An open surgical approach is more defi nitive treatment, although it is associated with greater risk and technical challenge.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Intraneural Ganglion Cyst Involving the Tibial Nerve

Patel¹,

Schucany²

2012

Baylor University Medical Center Proceedings

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“…Th e fi rst case of intraneural ganglion cyst of the tibial nerve was described in 1967. Since then, about 15 cases have been reported (1)(2)(3).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Rare Case of Intraneural Ganglion Cyst Involving the Tibial Nerve

Patel¹,

Schucany²

2012

Baylor University Medical Center Proceedings

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“…Intra‐neural ganglia occur within peripheral nerves and are located most frequently in the common peroneal nerve, but other sites of involvement include radial, ulnar, median, posterior interosseous and sciatic nerves. Involvement of the tibial nerve is infrequent, with the few cases described in the literature almost exclusively reported in adults . The first reported case of a tibial intra‐neural ganglion was described in 1967, and since then only 16 cases in adults and one case in a child have been documented in the literature .…”

Section: Discussionmentioning

confidence: 99%

“…Intra‐neural ganglia can cause compression of adjacent nerve fascicles. When the tibial nerve is involved, patients may present with posterior knee pain and paraesthesia . Knee pain is one of the most common musculoskeletal complaints seen in the paediatric population with many possible causes.…”

Section: Discussionmentioning

confidence: 99%

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Case of knee pain in a child: Intra‐neural ganglion of the tibial nerve

Palit

Paddle

Rozen

et al. 2015

J Paediatrics Child Health

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A 16-year-old, previously healthy boy, presented with an 11-month history of right popliteal fossa discomfort. This had been preceded by sudden pain in the posterior knee after falling while playing soccer. There was no effusion of the knee joint and no palpable mass. Sensory examination demonstrated no abnormalities, and deep tendon reflexes at the knee and ankle were normal and symmetric. He demonstrated mild weakness of toe flexion with normal strength of plantar flexion at the ankle. His gait was otherwise normal, and there was no evidence of meniscal or ligamentous injury.Plain X-ray and bone scan were unremarkable. Ultrasound examination revealed a cystic lesion, which was not easily compressible. Subsequent magnetic resonance imaging (MRI) of the right knee demonstrated a multilobulated tubular mass extending along the course of the distal sciatic and tibial nerves (Fig. 1). The lesion extended to the proximal tibiofibular joint. The common peroneal nerve was spared. There was evidence of denervation of tibialis posterior and flexor digitorum longus. Based on the imaging, an intra-neural ganglion was the most likely diagnosis; however, other differentials included a Baker's cyst or a peripheral nerve sheath tumour. Given the lesion was symptomatic, a decision to proceed with surgical intervention was made.A direct approach to the popliteal fossa was made via a lazy-S incision with the patient prone under general anaesthesia. Dissection revealed a grossly distended tibial nerve with a shiny fusiform appearance (Fig. 2). The epineurium was incised and a clear gelatinous fluid encountered, typical of ganglia (Fig. 3). Intra-neural dissection proceeded distally within the popliteal fossa and into the upper leg with careful preservation of the sural nerve and muscular branches. The lesion communicated with the proximal tibiofibular joint having expanded the articular branch to the joint. The lesion was divided from its origin at the joint and synovectomy of the capsule was performed. The distal tibial nerve was of normal appearance and calibre. The mass was dissected in a retrograde fashion proximally to the limit of the popliteal fossa. A cord of opaque, pale grey tissue (125 mm × 6-12 mm) was sent for histopathology. Sections showed fibrous tissue containing a multiloculated cavity without an epithelial lining with evidence of myxoid change in the stroma. Perineurial cells stained positive for epithelial membrane antigen in the outer wall of the cavity. These features were consistent with an intra-neural ganglion.The patient was reviewed regularly at 3, and then 6 monthly intervals post-operatively. He achieved restoration of full range of motion of the right leg, with only a small area of decreased sensation over the right lateral aspect of the foot, which is progressively diminishing in size.

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