Wilson Thomas J, Hébert-Blouin Marie-Noëlle, Murthy Naveen S, García Joaquín J, Amrami Kimberly K, Spinner Robert J
Departments of 1 Neurosurgery.
Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada.
Neurosurg Focus. 2017 Mar;42(3):E10. doi: 10.3171/2016.12.FOCUS16439.
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.
目的 作者观察到，因腓总神经病变前来评估、膝关节MRI检查结果为“阴性”的一部分患者，在随后更仔细的检查中发现有腓总神经内神经节囊肿的细微迹象。本研究的目的是介绍几乎不可见的腓总神经内神经节囊肿并提供实例。作者还想找出几乎不可见囊肿存在的线索。方法 回顾性分析并展示了显示几乎不可见的腓总神经内神经节囊肿的实例。对每个病例的病史、体格检查、影像学检查和术中发现进行了回顾。关注的结果是腓总神经内神经节囊肿随时间的大小和形态，相对于所进行的各种干预措施，以及与体格检查和电诊断结果的关系。结果 作者展示了一系列病例，突出了腓总神经内神经节囊肿的动态性质，并将几乎不可见的囊肿作为该谱系中一个新出现的部分进行介绍。这些病例显示了这些囊肿的神经内和神经外部分随时间的大小和形态变化。尽管MRI检查结果为“阴性”，但在一部分患者中仍可识别出几乎不可见的囊肿。结论 作者在此证明，腓总神经内神经节囊肿的大小和形态随时间会经历变化的过程，他们将几乎不可见的囊肿描述为该谱系的一端。他们找出了几乎不可见囊肿存在的线索，包括以腓深神经为主的症状、波动的症状、胫前肌的失神经改变以及胫腓上关节的异常，并将细微的影像学发现与腓总神经的内部束状结构相关联。对几乎不可见囊肿的描述可能会使人们对这种具有一系列表现的病理实体有更多的认识。
