Prasad Nikhil K, Desy Nicholas M, Howe B Matthew, Amrami Kimberly K, Spinner Robert J
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
Clin Anat. 2016 May;29(4):530-7. doi: 10.1002/ca.22671. Epub 2015 Dec 18.
Over the last decade, the mechanism of formation of intraneural ganglion cysts has been established through a meticulous review of clinical findings and correlation with patterns produced on magnetic resonance imaging (MRI). Pathognomonic imaging patterns distinguish these rare lesions from the more common extraneural variants in almost all cases. In this report, we present a new pattern of cyst occurrence in the subparaneurial compartment of the nerve and provide potential anatomic explanations for its pathogenesis. Using an anatomic framework of connective tissue compartments of the nerve, we reviewed 63 (56 fibular and seven tibial) intraneural ganglion cysts in the knee region evaluated at our institution and all reports with MRI in the world's literature for evidence of cyst occurrence in the subparaneurial compartment. We identified six cases (five in the common fibular nerve and one in the tibial nerve) at our institution that had MR evidence of cyst in the subparaneurial compartment with a new complex lobulated pattern. All cases had articular branch connections to the superior tibiofibular joint, which at operation were resected along with the joints. Follow-up revealed complete recovery in all instances and no clinical or radiological signs of recurrence. Three cases out of 80 in the literature exhibited the new complex lobulated MRI pattern. We present a new pattern of intraneural ganglion cyst occurrence in a potential space that surrounds peripheral nerves--the subparaneurial compartment. We believe that the unifying articular theory applies to the pathogenesis and management of these rare variants.
在过去十年中，通过对临床发现进行细致回顾并与磁共振成像（MRI）所呈现的模式进行关联，已明确了神经内腱鞘囊肿的形成机制。在几乎所有病例中，特征性的成像模式可将这些罕见病变与更为常见的神经外病变区分开来。在本报告中，我们展示了神经旁下间隙中囊肿出现的一种新模式，并为其发病机制提供了潜在的解剖学解释。利用神经结缔组织间隙的解剖框架，我们回顾了在本机构接受评估的63例（56例腓骨神经和7例胫神经）膝关节区域的神经内腱鞘囊肿，以及世界文献中所有有MRI检查的报告，以寻找神经旁下间隙中囊肿出现的证据。我们在本机构发现了6例（5例在腓总神经，1例在胫神经）在神经旁下间隙有囊肿的MR证据，呈现出新的复杂分叶模式。所有病例均有与胫腓上关节相连的关节分支，手术时连同关节一起切除。随访显示所有病例均完全康复，无复发的临床或影像学迹象。文献中的80例中有3例呈现出这种新的复杂分叶MRI模式。我们展示了神经内腱鞘囊肿在围绕周围神经的一个潜在间隙——神经旁下间隙中出现的一种新模式。我们认为统一的关节理论适用于这些罕见变异的发病机制和治疗。
