Abstract
Background
The objective of this study was to review an historical cohort of patients with peroneal neuropathy and magnetic resonance imaging (MRI) read as negative for mass or cyst to determine if occult peroneal intraneural ganglion cysts can be identified on subsequent imaging review and to use this as an estimation of how under-recognized this pathologic entity is.
Method
The patient cohort utilized in this study was a previously published control cohort of 11 patients with peroneal neuropathy and MRI read as negative for mass or cyst. Clinical history, neurologic examination, and MRI studies of the knee were reviewed for each of the included patients. The primary outcome of interest was the presence of peroneal intraneural ganglion cyst on MRI.
Results
Overall, 7 of 11 (64%) patients in this historical “normal” cohort had evidence of a peroneal intraneural ganglion cyst on subsequent review of imaging. Deep peroneal-predominant weakness, knee pain, and tibialis anterior-predominant denervation/atrophy were seen more commonly in patients in whom an intraneural cyst was identified.
Conclusions
This retrospective cohort study provides evidence that peroneal intraneural ganglion cysts are an historically under-recognized cause of peroneal neuropathy, with 64% of this historical “negative” cohort having evidence of a cyst on subsequent imaging review. Larger studies are needed to determine the treatment ramifications of identifying small cysts and to determine the clinical features suggestive of an intraneural ganglion cyst.
Similar content being viewed by others
References
Bignotti B, Cadoni A, Assini A, Martinoli C, Tagliafico A (2016) Fascicular involvement in common fibular neuropathy: evaluation with ultrasound. Muscle Nerve 53:532–537
Gustafson KJ, Grinberg Y, Joseph S, Triolo RJ (2012) Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes. J Rehabil Res Dev 49:309–321
Lee PP, Chalian M, Bizzell C, Williams EH, Rosson GD, Belzberg AJ, Eng J, Carrino JA, Chhabra A (2012) Magnetic resonance neurography of common peroneal (fibular) neuropathy. J Comput Assist Tomogr 36:455–461
Poage C, Roth C, Scott B (2016) Peroneal nerve palsy: evaluation and management. J Am Acad Orthopaedic Surg 24:1–10
Spinner RJ, Atkinson JL, Tiel RL (2003) Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99:330–343
Spinner RJ, Desy NM, Amrami KK (2016) The unifying articular (synovial) origin for intraneural ganglion cysts: moving beyond a theory. J Hand Surg 41:e223–224
Spinner RJ, Hebert-Blouin MN, Rock MG, Amrami KK (2011) Extreme intraneural ganglion cysts. J Neurosurg 114:217–224
Spinner RJ, Luthra G, Desy NM, Anderson ML, Amrami KK (2008) The clock face guide to peroneal intraneural ganglia: critical “times” and sites for accurate diagnosis. Skelet Radiol 37:1091–1099
Sunderland S, Ray LJ (1948) The intraneural topography of the sciatic nerve and its popliteal divisions in man. Brain 71:242–273
Visser LH (2006) High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology 67:1473–1475
Wilson TJ, Hebert-Blouin MN, Murthy NS, Garcia JJ, Amrami KK, Spinner RJ (2017) The nearly invisible intraneural cyst: a new and emerging part of the spectrum. Neurosurg Focus 42:E10
Young NP, Sorenson EJ, Spinner RJ, Daube JR (2009) Clinical and electrodiagnostic correlates of peroneal intraneural ganglia. Neurology 72:447–452
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Funding
No funding was received for this research.
Ethical approval/Informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Additional information
Comments
A very scholarly article on an entity that this group discovered and continue to mine.
Michel Kliot
CA, USA
Thomas J. Wilson and Marie-Nöelle Hébert-Blouin made an equal contribution to this manuscript
Rights and permissions
About this article
Cite this article
Wilson, T.J., Hébert-Blouin, MN., Murthy, N.S. et al. Recognition of peroneal intraneural ganglia in an historical cohort with “negative” MRIs. Acta Neurochir 159, 925–930 (2017). https://doi.org/10.1007/s00701-017-3130-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-017-3130-3