Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Neurosurgery. 2010 Sep;67(3 Suppl Operative):ons71-8; discussion ons78. doi: 10.1227/01.NEU.0000374683.91933.0E.
Recent research has resulted in an improved understanding of the pathogenesis and treatment of intraneural ganglia, particularly with respect to the most common form, the peroneal nerve at the fibular neck region.
To outline the mechanism for the development and propagation of intraneural ganglia located in the knee region, along with their treatment, as well as highlight how shared principles can be exploited for successful treatment of the more commonly occurring peroneal intraneural ganglia.
A surgical approach has been developed for peroneal intraneural cysts based on the pathogenesis. The treatment of the less common tibial intraneural cysts is designed along the same principles.
A strategy consisting of (1) disarticulation (resection) of the superior tibiofibular joint (ie, the source), (2) disconnection of the articular branch connection (ie, the conduit), and (3) decompression (rather than resection) of the cyst has improved outcomes and eliminated intraneural recurrences in peroneal intraneural cysts. These same principles and techniques can be applied to the rarer tibial intraneural ganglia derived from the same joint. The mechanism of development and propagation for intraneural cysts in the knee region as well as a surgical technique and its rational are described and illustrated.
Understanding the joint-related basis of intraneural cysts leads to simple targeted surgery that addresses the joint, its articular branch, and the cyst. The success of the shared surgical strategy for both peroneal and tibial intraneural ganglia confirms the principles of the unifying articular theory.
最近的研究使人们对神经内神经节的发病机制和治疗有了更好的理解，尤其是在最常见的腓骨颈区域腓总神经的形式。
概述位于膝关节区域的神经内神经节的发展和传播机制及其治疗方法，并强调如何利用共同的原则成功治疗更常见的腓肠神经内神经节。
根据发病机制，为腓肠神经内囊肿开发了一种手术方法。沿着相同的原则设计治疗较不常见的胫骨内神经囊肿。
由（1）距上胫腓关节（即源）的关节分离（切除），（2）关节分支连接的分离（即导管）和（3）囊肿的减压（而不是切除）组成的策略改善了结果，并消除了腓肠神经内囊肿中的神经内复发。这些相同的原则和技术可以应用于源自同一关节的更罕见的胫骨内神经节。描述并说明了膝关节神经内囊肿的发展和传播机制，以及手术技术及其合理性。
了解神经内囊肿的关节相关基础可导致针对关节及其关节分支和囊肿的简单靶向手术。腓肠神经和胫骨内神经节的共享手术策略的成功证实了关节理论的原则。
