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Does complete regression of intraneural ganglion cysts occur without surgery?

  • Review Article - : Peripheral Nerves
  • Published:
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Abstract

Purpose

The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention.

Methods

We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection.

Results

We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases.

Conclusion

We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.

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Author information

Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Karina A. Lenartowicz

  2. Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Nikhil K. Murthy, Alexandre S. Wolf & Robert J. Spinner

  3. Department of Orthopedics, University of Calgary, Alberta, Calgary, Canada

    Nicholas M. Desy

  4. Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA

    Nicole M. De La Pena

  5. Stanford University Medical Center, Stanford, CA, USA

    Thomas J. Wilson

  6. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Kimberly K. Amrami

Authors
  1. Karina A. Lenartowicz
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  2. Nikhil K. Murthy
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  4. Nicole M. De La Pena
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  5. Alexandre S. Wolf
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  7. Kimberly K. Amrami
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Contributions

Conceptualization: Nicole M. De La Pena, Thomas J. Wilson, Kimberly K. Amrami, and Robert J. Spinner; Data curation: Karina A. Lenartowicz, Nicholas M. Desy, Alexandre S. Wolf, and Kimberly K. Amrami; Formal analysis: Karina A. Lenartowicz, Nikhil K. Murthy, and Robert J. Spinner; Investigation: Nikhil K. Murthy and Alexandre S. Wolf; Methodology: Karina A. Lenartowicz, and Nicole M. De La Pena; Resources: Nicholas M. Desy; Software: Karina A. Lenartowicz, Nicholas M. Desy, and Alexandre S. Wolf; Supervision: Kimberly K. Amrami and Robert J. Spinner; Writing—original draft: Nikhil K. Murthy and Robert J. Spinner; Writing—review and editing: Karina A. Lenartowicz, Thomas J. Wilson, and Robert J. Spinner.

Corresponding author

Correspondence to Robert J. Spinner.

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Lenartowicz, K.A., Murthy, N.K., Desy, N.M. et al. Does complete regression of intraneural ganglion cysts occur without surgery?. Acta Neurochir 164, 2689–2698 (2022). https://doi.org/10.1007/s00701-022-05311-w

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