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The medial safe zone for treating intraneural ganglion cysts in the tarsal tunnel: a technical note

  • Technical Note - Peripheral Nerves
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Abstract

Introduction

Intraneural ganglion cysts in the tarsal tunnel are rare but are being increasingly reported. The cysts involve the tibial or plantar nerves and are most commonly derived from a neighboring (degenerative) joint, (i.e., the tibiotalar or subtalar) via an articular branch arising from the medial aspect of the nerve. We describe a safe zone for approaching these cysts in the tarsal tunnel that allows for identification of the joint connection without injury to important distal branches.

Methods

We present a case of an intraneural ganglion cyst within the tarsal tunnel in a patient with symptoms consistent with tarsal tunnel syndrome. Using intraoperative photographs and artist rendering, we describe a technique to safely disconnect the abnormal joint connection while preserving the important distal branches of the tibial nerve.

Conclusion

The safe zone for the tibial nerve in the tarsal tunnel can be exposed by mobilization and gentle retraction of the vascular bundle. In cases of intraneural ganglion cysts, all apparent connections between the nerve and degenerative joints within this safe zone can be resected without injury to important distal nerve branches.

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Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Ross C. Puffer & Robert J. Spinner

Authors
  1. Ross C. Puffer
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  2. Robert J. Spinner
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Corresponding author

Correspondence to Robert J. Spinner.

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IRB approval was obtained for this study.

All patients included signed consent forms for the use of non-identifying medical information in medical research, including this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Comments

Excellent article describing how to deal with a surgically challenging ganglion cyst involving the tibial nerve and it's distal branches with excellent intraoperative photographs and schematic illustrations.

Michel Kliot

CA, USA

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This article is part of the Topical Collection on Peripheral Nerves

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Puffer, R.C., Spinner, R.J. The medial safe zone for treating intraneural ganglion cysts in the tarsal tunnel: a technical note. Acta Neurochir 161, 2129–2132 (2019). https://doi.org/10.1007/s00701-019-04027-8

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  • DOI: https://doi.org/10.1007/s00701-019-04027-8

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