Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota;
Departments of 2 Neurologic Surgery.
J Neurosurg. 2016 Sep;125(3):615-30. doi: 10.3171/2015.9.JNS141368. Epub 2016 Jan 22.
OBJECTIVE The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. METHODS In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. RESULTS In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.
神经内腱鞘囊肿的病因一直存在争议。近年来，大量证据支持其发病机制的关节（滑膜）理论。作者试图：1）对世界范围内有关神经内囊肿的文献进行系统回顾，2）重新解读其他作者发表的文章中可用的磁共振成像（MRI）图像，以识别未被认识到的关节连接。
在第 1 部分中，对所有病例进行了人口统计学数据、症状持续时间、创伤史、是否进行肌电图或神经传导研究、影像学类型、手术治疗、关节连接、神经内囊肿复发和术后影像学检查等分析。完成了 2 项单变量分析：1）比较每十年发表的神经内腱鞘囊肿文献比例，2）评估 1914 年至 2003 年与 2004 年至 2015 年之间的复发次数。使用 3 个多变量回归模型来确定神经内囊肿复发的危险因素。在第 2 部分中，作者分析了所有可用的发表的 MRI 图像，并从原始作者未识别关节连接的选定病例中获得 MRI 图像，专门寻找未被识别的关节连接。进行了 2 项单变量分析：1）确定识别关节连接与获得 MRI 之间的可能关联，2）评估 1914 年至 2003 年与 2004 年至 2015 年之间报告的关节连接数量。
在第 1 部分中，选择了 417 篇文章（645 例患者）进行分析。在 313 个神经内囊肿（48%）中发现了关节连接。自 2004 年以来，神经内腱鞘囊肿病例和囊肿复发的报告更为频繁（均具有统计学显著性差异）。囊肿复发与经皮抽吸以及未能断开关节分支或解决关节问题之间存在统计学显著关联。在第 2 部分中，作者发现了 43 个最初未被识别的关节连接：27 个基于对已发表病例的 MRI 图像的回顾性重新解读，16 个来自对已发表病例原始 MRI 图像的抽样。总体而言，接受 MRI 检查的患者更常发现关节连接，并且在 2004 年至 2015 年期间更频繁地报告（均具有统计学显著性差异）。
对世界范围内文献和 MRI 图像的全面回顾进一步支持了关节（滑膜）理论，并为未来的研究者提供了基线数据。
