Skip to main content

Advertisement

SpringerLink
Log in

Tibial intraneural ganglion cysts at the superior tibiofibular joint treated with joint resection alone: a proof of concept

  • Original Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Intraneural ganglion cysts involving the tibial nerve are rare. Recent evidence has supported an articular (synovial) theory to explain the joint-related origin of these cysts; however, optimal operative treatment for cysts originating from the STFJ remains poorly understood. Therefore, we present a novel strategy: addressing the joint itself without addressing the articular branch and/or the cyst.

Methods

Records of patients with tibial intraneural ganglion cysts with a connection to the STFJ who were treated with a joint resection alone at a single academic institution were reviewed. The clinicoradiographic features, operative intervention, and postoperative course were recorded.

Results

We identified a consecutive series of 7 patients. These patients (4/7 male, 57%) were 43 (range 34–61) years of age and all presented with symptoms of neuropathy. The patients underwent resection of the synovial surfaces of the STFJ without disconnection of the articular branch or decompression of the cyst. Postoperatively, three patients regained partial motor function (43%, n=7), although four patients noted continued sensory abnormality (57%, 4/7). All six patients with postoperative MRIs had some evidence of regression of the cyst.

Conclusions

This novel surgical technique serves as a proof of concept—highlighting the fact that treating the primary source (the joint origin) can be effective in eliminating the secondary problem (the cyst itself). While this study shows that this simplified approach can be employed in select cases, we believe that superior results (faster, fuller recovery) can be achieved with combinations of disconnecting the articular branch, decompressing the cyst, and/or resecting the joint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

MR imaging:

Magnetic resonance imaging

MUAP:

Motor unit action potentials

STFJ:

Superior tibiofibular joint

T:

Tesla

References

  1. Buckley CE, Tong E, Spence LD, O’Shaughnessy M (2017) Intraneural ganglion cyst involving the tibial nerve—a case report. BJR Case Rep 3(2):20160116

    PubMed  PubMed Central  Google Scholar 

  2. Desy NM, Lipinski LJ, Tanaka S, Amrami KK, Rock MG, Spinner RJ (2015) Recurrent intraneural ganglion cysts: pathoanatomic patterns and treatment implications. Clin Anat 28:1058–1069

    Article  PubMed  Google Scholar 

  3. Desy NM, Wang H, Elshiekh MAI, Tanaka S, Choi TW, Howe BM, Spinner RJ (2016) Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 125:615–630

    Article  PubMed  Google Scholar 

  4. Fricke T, Schmitt AD, Jansen O (2019) Intraneural ganglion cysts of the lower limb. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, vol 08. © Georg Thieme Verlag KG, pp 732–738

    Google Scholar 

  5. Friedlander HL (1967) Intraneural ganglion of the tibial nerve: a case report. JBJS 49:519–522

    Article  CAS  Google Scholar 

  6. Huntington LS, Talia A, Devitt BM, Batty L (2022) Management and outcomes of proximal tibiofibular joint ganglion cysts: a systematic review. Knee 37:60–70

    Article  PubMed  Google Scholar 

  7. Lenartowicz KA, Murthy NK, Desy NM, De La Pena NM, Wolf AS, Wilson TJ, Amrami KK, Spinner RJ (2022) Does complete regression of intraneural ganglion cysts occur without surgery? Acta Neurochir 164(10):2689–2698

    Article  PubMed  Google Scholar 

  8. Lipinski LJ, Rock MG, Spinner RJ (2015) Peroneal intraneural ganglion cysts at the fibular neck: the layered “U” surgical approach to the articular branch and superior tibiofibular joint. Acta Neurochir 157:837–840

    Article  PubMed  Google Scholar 

  9. Mayer SL, Grewal JS, Gloe T, Khasho CA, Harder S (2021) A rare case of tibial intraneural ganglion cyst arising from the tibiofibular joint. Cureus 13:e13570

    PubMed  PubMed Central  Google Scholar 

  10. McGraw T (1871) Cystic tumor of the popliteal nerve. Detroit Rev Med Pharm 6:304–306

    Google Scholar 

  11. Panwar J, Mathew A, Thomas BP (2017) Cystic lesions of peripheral nerves: are we missing the diagnosis of the intraneural ganglion cyst? World J Radiol 9:230

    Article  PubMed  PubMed Central  Google Scholar 

  12. Patel C, Vishnubhakat SM, Narayan R (2015) Fascicular involvement of the posterior tibial nerve as a result of perineural ganglion cyst at the posterior tibial nerve in the calf: a case report and review of literature. J Clin Neuromuscul Dis 17:84–87

    Article  PubMed  Google Scholar 

  13. Prasad N, Wolanskyj AP, Amrami KK, Spinner RJ (2016) Clinical anatomy leading the way for solutions: an important paradigm for translational research, vol 29. Wiley Online Library

    Google Scholar 

  14. Reichler B, Sneag D (2015) Magnetic resonance imaging and electrodiagnostic features of proximal tibial nerve compression by a ganglion cyst. In: Muscle and Nerve. Wiley-Blackwell, pp S110–S110

    Google Scholar 

  15. Roger J, Chauvin F, Bertani A, Rongieras F, Vitry T, Le Moigne F, Drouet A (2016) Synovial cyst of the knee: a rare case of acute sciatic neuropathy. Ann Phys Rehabil Med 60:274–276

    Article  PubMed  Google Scholar 

  16. Spinner RJ, Atkinson JL, Harper CM, Wenger DE (2000) Recurrent intraneural ganglion cyst of the tibial nerve: case report. J Neurosurg 92:334–337

    Article  CAS  PubMed  Google Scholar 

  17. Spinner RJ, Atkinson JL, Tiel RL (2003) Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99:330–343

    Article  PubMed  Google Scholar 

  18. Spinner RJ, Desy NM, Agarwal G, Pawlina W, Kalra M, Amrami KK (2013) Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint-connected. Clin Anat 26:267–281

    Article  PubMed  Google Scholar 

  19. Spinner RJ, Desy NM, Amrami KK (2016) The unifying articular (synovial) origin for intraneural ganglion cysts: moving beyond a theory. J Hand Surg Am 41:e223–e224. https://doi.org/10.1016/j.jhsa.2016.04.004

    Article  PubMed  Google Scholar 

  20. Spinner RJ, Hébert-Blouin M-N, Rock MG, Amrami KK (2011) Extreme intraneural ganglion cysts. J Neurosurg 114:217–224

    Article  PubMed  Google Scholar 

  21. Spinner RJ, Hébert-Blouin M-N, Skinner JA, Amrami KK (2010) Knee MR arthrographic proof of an articular origin for combined intraneural and adventitial cysts. Acta Neurochir 152:919–923

    Article  PubMed  Google Scholar 

  22. Spinner RJ, Mokhtarzadeh A, Schiefer TK, Krishnan KG, Kliot M, Amrami KK (2007) The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint. Skeletal Radiol 36:281–292

    Article  PubMed  Google Scholar 

  23. Spinner RJ, Wang H, Angius D, Malik AG, Malghem J, Amrami KK (2011) A modern perspective on the earliest description of an intraneural ganglion cyst arising from the knee joint. Clin Anat 24:106–112

    Article  PubMed  Google Scholar 

  24. Vandenbulcke R, Marrannes J, Vandenbulcke B, Herman M, Laridon E, Van Holsbeeck B (2015) Intraneural ganglion cyst of the tibial nerve. J Belgian Soc Radiol 99:125

    Article  CAS  Google Scholar 

  25. Vetchy V, Aszmann OC, Laengle G, Platzgummer H (2023) Intraneural ganglion cyst of the tibial nerve originating from a posterior knee joint branch. Case report on the use of high-resolution volumetric ultrasound and magnetic resonance neurography. Ultraschall Med. https://doi.org/10.1055/a-2003-0999

  26. Wang J, Hui C, Campbell W, Claydon M (2021) Unusual case of an intraneural ganglion cyst of the tibial nerve. ANZ J Surg 92(6):1565–1566. https://doi.org/10.1111/ans.17345

  27. Wilson TJ, Mauermann ML, Rock MG, Spinner RJ (2018) Outcomes following surgery for peroneal intraneural ganglion cysts. Muscle Nerve 57(6):989–993

    Article  PubMed  Google Scholar 

  28. Wilson TJ, Stone JJ, Howe BM, Rock MG, Spinner RJ (2020) Joint outcomes following surgery for superior tibiofibular joint-associated peroneal intraneural ganglion cysts. Neurosurgery 86:383–390

    Article  PubMed  Google Scholar 

  29. Yangi K, Demir DD, Ince O, Hof M (2023) A huge intraneural ganglion cyst of tibial nerve in a 78-year-old male patient with gonarthrosis: a case report and review of the literature. Cureus:1–7. https://doi.org/10.7759/cureus

Download references

Author information

Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, 55905, USA

    Karina Lenartowicz

  2. Departments of Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA

    B. Matthew Howe & Kimberly K. Amrami

  3. Department of Orthopedics, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Nicholas M. Desy

  4. Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, 55905, USA

    Matthew T. Houdek & Robert J. Spinner

  5. Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, 55905, USA

    Robert J. Spinner

Authors
  1. Karina Lenartowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Matthew Howe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kimberly K. Amrami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicholas M. Desy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew T. Houdek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert J. Spinner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Spinner.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenartowicz, K., Howe, B.M., Amrami, K.K. et al. Tibial intraneural ganglion cysts at the superior tibiofibular joint treated with joint resection alone: a proof of concept. Acta Neurochir 165, 2581–2588 (2023). https://doi.org/10.1007/s00701-023-05639-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05639-x

Keywords

Search

Navigation