Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve

Abstract

Background

Intraneural ganglion cysts are rare, benign, mucinous lesions that occur within neural sheaths and are thought to involve cystic fluid exiting from nearby synovial joints. They often present as tender masses causing paresthesias in the distribution of the involved nerve, muscle weakness or cramping, or localized or referred pain.

Case Description

We present a case of a patient who initially presented with foot drop due to an intraneural ganglion cyst of the common peroneal nerve. This cyst was successfully treated using ultrasound guidance to aspirate the cyst and inject corticosteroid to prevent further inflammation.

Literature Review

Standard of care has previously involved surgical resection, but this has been associated with a high frequency of recurrence. Due to the risks of nerve and vessel damage, there have been efforts to find alternative ways of resolving these cysts.

Purposes and Clinical Relevance

Aspiration and injection of corticosteroid is a useful and minimally invasive alternative to surgery for managing intraneural ganglion cysts.

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References

  1. 1.

    Adn M, Hamlat A, Morandi H, Guegan Y. Intraneural ganglion cyst of the tibial nerve. Acta Neurochir. 2006; 148: 885-890.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Iverson DJ. MRI detection of cysts of the knee causing common peroneal neuropathy. Neurology. 2005; 65: 1829-1831.

    PubMed  Article  Google Scholar 

  3. 3.

    Jose J, Fourzali R, Lesniak B, Kaplan L. Ultrasound guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve. Skeletal Radiol. 2011; 40: 1473-1478.

    PubMed  Article  Google Scholar 

  4. 4.

    Nakamichi K, Tachibana S. Ganglion-associated ulnar tunnel syndrome treated by ultrasonographically assisted aspiration and splinting. J Hand Surg Br. 2003; 28: 177-178.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Omoumi P, de Gheldere A, Leemirijse T, et al. Value of computed tomography arthrography with delayed acquisitions in the workup of ganglion cysts of the tarsal tunnel: report of three cases. Skeletal Radiol. 2010; 39: 381-386.

    PubMed  Article  Google Scholar 

  6. 6.

    Saboeiro G, Sofka CM. Ultrasound-guided ganglion cyst aspiration. HSS J. 2008; 4: 161-163.

    PubMed  Article  Google Scholar 

  7. 7.

    Spinner RJ, Atkinson JL, Tiel RL. Peroneal intraneural ganglia: the importance of the articular branch, a unifying theory. J Neurosurg. 2003; 99: 330-343.

    PubMed  Article  Google Scholar 

  8. 8.

    Spinner RJ, Desy NM, Rock MG, Amrami KK. Peroneal intraneural ganglia part I: techniques for successful diagnosis and treatment. Neurosurg Focus. 2007; 22: 1-10.

    Google Scholar 

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Disclosures

Conflict of interest:

Teresa Liang, BSc; Anukul Panu, MD; Sean Crowther, MB BCh; Robert Lambert, MB BCh; and Gavin Low, MBChB, have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

N/A

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Correspondence to Anukul Panu MD, FRCPC.

Additional information

Work was performed at the Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Walter Mackenzie Center, 8440-112 St, Edmonton, AB T6G 2B7 Canada.

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Liang, T., Panu, A., Crowther, S. et al. Ultrasound-Guided Aspiration and Injection of an Intraneural Ganglion Cyst of the Common Peroneal Nerve. HSS Jrnl 9, 270–274 (2013). https://doi.org/10.1007/s11420-013-9345-9

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Keywords

  • intraneural ganglion cyst
  • common peroneal nerve
  • ultrasound-guided aspiration
  • denervation edema
  • foot drop