journal article
Mar 01, 2017
The nearly invisible intraneural cyst: a new and emerging part of the spectrum
Abstract
OBJECTIVE
The authors have observed that a subset of patients referred for evaluation of peroneal neuropathy with “negative” findings on MRI of the knee have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer inspection. The objective of this study was to introduce the nearly invisible peroneal intraneural ganglion cyst and provide illustrative cases. The authors further wanted to identify clues to the presence of a nearly invisible cyst.
METHODS
Illustrative cases demonstrating nearly invisible peroneal intraneural ganglion cysts were retrospectively reviewed and are presented. Case history and physical examination, imaging, and intraoperative findings were reviewed for each case. The outcomes of interest were the size and configuration of peroneal intraneural ganglion cysts over time, relative to various interventions that were performed, and in relation to physical examination and electrodiagnostic findings.
RESULTS
The authors present a series of cases that highlight the dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly invisible cyst as a new and emerging part of the spectrum. The cases demonstrate changes in size and morphology over time of both the intraneural and extraneural compartments of these cysts. Despite “negative” MR imaging findings, nearly invisible cysts can be identified in a subset of patients.
CONCLUSIONS
The authors demonstrate here that peroneal intraneural ganglion cysts ride a roller coaster of change in both size and morphology over time, and they describe the nearly invisible cyst as one end of the spectrum. They identified clues to the presence of a nearly invisible cyst, including deep peroneal predominant symptoms, fluctuating symptoms, denervation changes in the tibialis anterior muscle, and abnormalities of the superior tibiofibular joint, and they correlate the subtle imaging findings to the internal fascicular topography of the common peroneal nerve. The description of the nearly invisible cyst may allow for increased recognition of this pathological entity that occurs with a spectrum of findings.
The authors have observed that a subset of patients referred for evaluation of peroneal neuropathy with “negative” findings on MRI of the knee have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer inspection. The objective of this study was to introduce the nearly invisible peroneal intraneural ganglion cyst and provide illustrative cases. The authors further wanted to identify clues to the presence of a nearly invisible cyst.
METHODS
Illustrative cases demonstrating nearly invisible peroneal intraneural ganglion cysts were retrospectively reviewed and are presented. Case history and physical examination, imaging, and intraoperative findings were reviewed for each case. The outcomes of interest were the size and configuration of peroneal intraneural ganglion cysts over time, relative to various interventions that were performed, and in relation to physical examination and electrodiagnostic findings.
RESULTS
The authors present a series of cases that highlight the dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly invisible cyst as a new and emerging part of the spectrum. The cases demonstrate changes in size and morphology over time of both the intraneural and extraneural compartments of these cysts. Despite “negative” MR imaging findings, nearly invisible cysts can be identified in a subset of patients.
CONCLUSIONS
The authors demonstrate here that peroneal intraneural ganglion cysts ride a roller coaster of change in both size and morphology over time, and they describe the nearly invisible cyst as one end of the spectrum. They identified clues to the presence of a nearly invisible cyst, including deep peroneal predominant symptoms, fluctuating symptoms, denervation changes in the tibialis anterior muscle, and abnormalities of the superior tibiofibular joint, and they correlate the subtle imaging findings to the internal fascicular topography of the common peroneal nerve. The description of the nearly invisible cyst may allow for increased recognition of this pathological entity that occurs with a spectrum of findings.
Topics
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References
46
[1]
Desy NM, Wang H, Elshiekh MA, Tanaka S, Choi TW, Howe BM, : Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 125:615–630, 2016
[2]
Gustafson KJ, Grinberg Y, Joseph S, Triolo RJ: Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes. J Rehabil Res Dev 49:309–321, 2012
[3]
Lipinski LJ, Rock MG, Spinner RJ: Peroneal intraneural ganglion cysts at the fibular neck: the layered “U” surgical approach to the articular branch and superior tibiofibular joint. Acta Neurochir (Wien) 157:837–840, 2015
[4]
Prasad N, Amrami KK, Yangi K, Spinner RJ: Occult isolated articular branch cyst of the lateral plantar nerve. J Foot Ankle Surg 56:78–81, 2017
[5]
Puffer RC, Spinner RJ, Amrami KK, Skinner JA: Direct superior tibiofibular joint arthrography demonstrates consistent communication with the tibiofemoral joint. Clin Anat 27:1128–1129, 2014
[6]
Puffer RC, Spinner RJ, Murthy NS, Amrami KK: CT and MR arthrograms demonstrate a consistent communication between the tibiofemoral and superior tibiofibular joints. Clin Anat 26:253–257, 2013
[7]
Scherman BM, Bilbao JM, Hudson AR, Briggs SJ: Intraneural ganglion: a case report with electron microscopic observations. Neurosurgery 8:487–490, 1981
[8]
Shahid KR, Hébert-Blouin MN, Amrami KK, Spinner RJ: Extraneural rupture of intraneural ganglion cysts. J Surg Orthop Adv 20:136–141, 2011
[9]
Spinner RJ, Amrami KK: Intraneural ganglion of the suprascapular nerve: case report. J Hand Surg Am 31:1698–1699, 2006
[10]
Spinner RJ, Amrami KK, Angius D, Wang H, Carmichael SW: Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments. Neurosurg Focus 22:6E17, 2007
[11]
Spinner RJ, Amrami KK, Kliot M, Johnston SP, Casañas J: Suprascapular intraneural ganglia and glenohumeral joint connections. J Neurosurg 104:551–557, 2006
[12]
Spinner RJ, Amrami KK, Rock MG: The use of MR arthrography to document an occult joint communication in a recurrent peroneal intraneural ganglion. Skeletal Radiol 35:172–179, 2006
[13]
Spinner RJ, Amrami KK, Wolanskyj AP, Desy NM, Wang H, Benarroch EE, : Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg 107:296–307, 2007
[14]
Spinner RJ, Atkinson JL, Scheithauer BW, Rock MG, Birch R, Kim TA, : Peroneal intraneural ganglia: the importance of the articular branch. Clinical series. J Neurosurg 99:319–329, 2003
[15]
Spinner RJ, Atkinson JL, Tiel RL: Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99:330–343, 2003
[16]
Spinner RJ, Desy NM, Amrami KK: Sequential tibial and peroneal intraneural ganglia arising from the superior tibiofibular joint. Skeletal Radiol 37:79–84, 2008
[17]
Spinner RJ, Desy NM, Amrami KK: The unifying articular (synovial) origin for intraneural ganglion cysts: moving beyond a theory.. J Hand Surg Am 41:e223–e224, 2016
[18]
Spinner RJ, Hébert-Blouin MN, Rock MG, Amrami KK: Extreme intraneural ganglion cysts. J Neurosurg 114:217–224, 2011
[19]
Spinner RJ, Hébert-Blouin MN, Skinner JA, Amrami KK: Knee MR arthrographic proof of an articular origin for combined intraneural and adventitial cysts. Acta Neurochir (Wien) 152:919–923, 2010
[20]
Spinner RJ, Luthra G, Desy NM, Anderson ML, Amrami KK: The clock face guide to peroneal intraneural ganglia: critical “times” and sites for accurate diagnosis. Skeletal Radiol 37:1091–1099, 2008
[21]
Sunderland S, Ray LJ: The intraneural topography of the sciatic nerve and its popliteal divisions in man. Brain 71:242–273, 1948
[22]
Visser LH: High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology 67:1473–1475, 2006
[23]
Young NP, Sorenson EJ, Spinner RJ, Daube JR: Clinical and electrodiagnostic correlates of peroneal intraneural ganglia. Neurology 72:447–452, 2009
[24]
Desy NM, Wang H, Elshiekh MA, Tanaka S, Choi TW, Howe BM, : Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 125:615–630, 2016
[25]
Gustafson KJ, Grinberg Y, Joseph S, Triolo RJ: Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes. J Rehabil Res Dev 49:309–321, 2012
[26]
Lipinski LJ, Rock MG, Spinner RJ: Peroneal intraneural ganglion cysts at the fibular neck: the layered “U” surgical approach to the articular branch and superior tibiofibular joint. Acta Neurochir (Wien) 157:837–840, 2015
[27]
Prasad N, Amrami KK, Yangi K, Spinner RJ: Occult isolated articular branch cyst of the lateral plantar nerve. J Foot Ankle Surg 56:78–81, 2017
[28]
Puffer RC, Spinner RJ, Amrami KK, Skinner JA: Direct superior tibiofibular joint arthrography demonstrates consistent communication with the tibiofemoral joint. Clin Anat 27:1128–1129, 2014
[29]
Puffer RC, Spinner RJ, Murthy NS, Amrami KK: CT and MR arthrograms demonstrate a consistent communication between the tibiofemoral and superior tibiofibular joints. Clin Anat 26:253–257, 2013
[30]
Scherman BM, Bilbao JM, Hudson AR, Briggs SJ: Intraneural ganglion: a case report with electron microscopic observations. Neurosurgery 8:487–490, 1981
[31]
Shahid KR, Hébert-Blouin MN, Amrami KK, Spinner RJ: Extraneural rupture of intraneural ganglion cysts. J Surg Orthop Adv 20:136–141, 2011
[32]
Spinner RJ, Amrami KK: Intraneural ganglion of the suprascapular nerve: case report. J Hand Surg Am 31:1698–1699, 2006
[33]
Spinner RJ, Amrami KK, Angius D, Wang H, Carmichael SW: Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments. Neurosurg Focus 22:6E17, 2007
[34]
Spinner RJ, Amrami KK, Kliot M, Johnston SP, Casañas J: Suprascapular intraneural ganglia and glenohumeral joint connections. J Neurosurg 104:551–557, 2006
[35]
Spinner RJ, Amrami KK, Rock MG: The use of MR arthrography to document an occult joint communication in a recurrent peroneal intraneural ganglion. Skeletal Radiol 35:172–179, 2006
[36]
Spinner RJ, Amrami KK, Wolanskyj AP, Desy NM, Wang H, Benarroch EE, : Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg 107:296–307, 2007
[37]
Spinner RJ, Atkinson JL, Scheithauer BW, Rock MG, Birch R, Kim TA, : Peroneal intraneural ganglia: the importance of the articular branch. Clinical series. J Neurosurg 99:319–329, 2003
[38]
Spinner RJ, Atkinson JL, Tiel RL: Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99:330–343, 2003
[39]
Spinner RJ, Desy NM, Amrami KK: Sequential tibial and peroneal intraneural ganglia arising from the superior tibiofibular joint. Skeletal Radiol 37:79–84, 2008
[40]
Spinner RJ, Desy NM, Amrami KK: The unifying articular (synovial) origin for intraneural ganglion cysts: moving beyond a theory.. J Hand Surg Am 41:e223–e224, 2016
[41]
Spinner RJ, Hébert-Blouin MN, Rock MG, Amrami KK: Extreme intraneural ganglion cysts. J Neurosurg 114:217–224, 2011
[42]
Spinner RJ, Hébert-Blouin MN, Skinner JA, Amrami KK: Knee MR arthrographic proof of an articular origin for combined intraneural and adventitial cysts. Acta Neurochir (Wien) 152:919–923, 2010
[43]
Spinner RJ, Luthra G, Desy NM, Anderson ML, Amrami KK: The clock face guide to peroneal intraneural ganglia: critical “times” and sites for accurate diagnosis. Skeletal Radiol 37:1091–1099, 2008
[44]
Sunderland S, Ray LJ: The intraneural topography of the sciatic nerve and its popliteal divisions in man. Brain 71:242–273, 1948
[45]
Visser LH: High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology 67:1473–1475, 2006
[46]
Young NP, Sorenson EJ, Spinner RJ, Daube JR: Clinical and electrodiagnostic correlates of peroneal intraneural ganglia. Neurology 72:447–452, 2009
Metrics
24
Citations
46
References
Details
- Published
- Mar 01, 2017
- Vol/Issue
- 42(3)
- Pages
- E10
Authors
Cite This Article
Thomas J. Wilson, Marie-Noëlle Hébert-Blouin, Naveen S. Murthy, et al. (2017). The nearly invisible intraneural cyst: a new and emerging part of the spectrum. Neurosurgical Focus, 42(3), E10. https://doi.org/10.3171/2016.12.focus16439
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