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The nearly invisible intraneural cyst: a new and emerging part of the spectrum.

Abstract OBJECTIVE The authors have observed that a subset of patients referred for evaluation of peroneal neuropathy with "negative" findings on MRI of the knee have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer inspection. The objective of this study was to introduce the nearly invisible peroneal intraneural ganglion cyst and provide illustrative cases. The authors further wanted to identify clues to the presence of a nearly invisible cyst. METHODS Illustrative cases demonstrating nearly invisible peroneal intraneural ganglion cysts were retrospectively reviewed and are presented. Case history and physical examination, imaging, and intraoperative findings were reviewed for each case. The outcomes of interest were the size and configuration of peroneal intraneural ganglion cysts over time, relative to various interventions that were performed, and in relation to physical examination and electrodiagnostic findings. RESULTS The authors present a series of cases that highlight the dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly invisible cyst as a new and emerging part of the spectrum. The cases demonstrate changes in size and morphology over time of both the intraneural and extraneural compartments of these cysts. Despite "negative" MR imaging findings, nearly invisible cysts can be identified in a subset of patients. CONCLUSIONS The authors demonstrate here that peroneal intraneural ganglion cysts ride a roller coaster of change in both size and morphology over time, and they describe the nearly invisible cyst as one end of the spectrum. They identified clues to the presence of a nearly invisible cyst, including deep peroneal predominant symptoms, fluctuating symptoms, denervation changes in the tibialis anterior muscle, and abnormalities of the superior tibiofibular joint, and they correlate the subtle imaging findings to the internal fascicular topography of the common peroneal nerve. The description of the nearly invisible cyst may allow for increased recognition of this pathological entity that occurs with a spectrum of findings.
PMID
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Authors

Mayor MeshTerms
Keywords

EMG = electromyography

STFJ = superior tibiofibular joint

articular branch

ganglion cyst

intraneural

peroneal nerve

superior tibiofibular joint

Journal Title neurosurgical focus
Publication Year Start




PMID- 28245669
OWN - NLM
STAT- MEDLINE
DA  - 20170301
DCOM- 20170308
LR  - 20170308
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 42
IP  - 3
DP  - 2017 Mar
TI  - The nearly invisible intraneural cyst: a new and emerging part of the spectrum.
PG  - E10
LID - 10.3171/2016.12.FOCUS16439 [doi]
AB  - OBJECTIVE The authors have observed that a subset of patients referred for
      evaluation of peroneal neuropathy with "negative" findings on MRI of the knee
      have subtle evidence of a peroneal intraneural ganglion cyst on subsequent closer
      inspection. The objective of this study was to introduce the nearly invisible
      peroneal intraneural ganglion cyst and provide illustrative cases. The authors
      further wanted to identify clues to the presence of a nearly invisible cyst.
      METHODS Illustrative cases demonstrating nearly invisible peroneal intraneural
      ganglion cysts were retrospectively reviewed and are presented. Case history and 
      physical examination, imaging, and intraoperative findings were reviewed for each
      case. The outcomes of interest were the size and configuration of peroneal
      intraneural ganglion cysts over time, relative to various interventions that were
      performed, and in relation to physical examination and electrodiagnostic
      findings. RESULTS The authors present a series of cases that highlight the
      dynamic nature of peroneal intraneural ganglion cysts and introduce the nearly
      invisible cyst as a new and emerging part of the spectrum. The cases demonstrate 
      changes in size and morphology over time of both the intraneural and extraneural 
      compartments of these cysts. Despite "negative" MR imaging findings, nearly
      invisible cysts can be identified in a subset of patients. CONCLUSIONS The
      authors demonstrate here that peroneal intraneural ganglion cysts ride a roller
      coaster of change in both size and morphology over time, and they describe the
      nearly invisible cyst as one end of the spectrum. They identified clues to the
      presence of a nearly invisible cyst, including deep peroneal predominant
      symptoms, fluctuating symptoms, denervation changes in the tibialis anterior
      muscle, and abnormalities of the superior tibiofibular joint, and they correlate 
      the subtle imaging findings to the internal fascicular topography of the common
      peroneal nerve. The description of the nearly invisible cyst may allow for
      increased recognition of this pathological entity that occurs with a spectrum of 
      findings.
FAU - Wilson, Thomas J
AU  - Wilson TJ
AD  - Departments of 1 Neurosurgery.
FAU - Hebert-Blouin, Marie-Noelle
AU  - Hebert-Blouin MN
AD  - Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec,
      Canada.
FAU - Murthy, Naveen S
AU  - Murthy NS
AD  - Radiology, and.
FAU - Garcia, Joaquin J
AU  - Garcia JJ
AD  - Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and.
FAU - Amrami, Kimberly K
AU  - Amrami KK
AD  - Radiology, and.
FAU - Spinner, Robert J
AU  - Spinner RJ
AD  - Departments of 1 Neurosurgery.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Ganglion Cysts/*diagnostic imaging/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peroneal Neuropathies/*diagnostic imaging/*surgery
MH  - Retrospective Studies
OTO - NOTNLM
OT  - *EMG = electromyography
OT  - *STFJ = superior tibiofibular joint
OT  - *articular branch
OT  - *ganglion cyst
OT  - *intraneural
OT  - *peroneal nerve
OT  - *superior tibiofibular joint
EDAT- 2017/03/02 06:00
MHDA- 2017/03/09 06:00
CRDT- 2017/03/02 06:00
AID - 10.3171/2016.12.FOCUS16439 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2017 Mar;42(3):E10. doi: 10.3171/2016.12.FOCUS16439.

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