Ratanshi Imran, Clark Tod A, Giuffre Jennifer L
Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Plast Surg (Oakv). 2018 May;26(2):80-84. doi: 10.1177/2292550317747844. Epub 2018 Jan 9.
Intraneural ganglion cysts, which occur within the common peroneal nerve, are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presented with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to flexor hallucis longus to a motor branch of anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, no evidence of recurrence and was able to bear weight without the need for orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
发生于腓总神经内的神经内腱鞘囊肿是足下垂的罕见病因。目前，针对累及腓总神经的神经内腱鞘囊肿的标准治疗方法包括：（1）囊肿减压；（2）结扎关节神经分支以防止复发。对于高位腓总神经麻痹患者，神经移位是恢复踝关节背屈功能的一种具有时间依赖性的策略；然而，这种方法尚未应用于累及腓总神经的神经内腱鞘囊肿。我们报告一例74岁女性因神经内腱鞘囊肿继发腓总神经麻痹的病例。该患者有5个月的右腓总神经分布区疼痛及足下垂病史。患者接受了囊肿减压、关节神经分支结扎以及将拇长屈肌运动支移位至胫前肌运动支的手术。在末次随访时，患者踝关节背屈完全恢复（M4+），无疼痛，无复发迹象，无需矫形支具支持即可负重。鉴于供区并发症轻微且踝关节背屈功能得以恢复，本报告强调了对于因神经内腱鞘囊肿导致的高位腓总神经病变患者，考虑早期进行神经移位的重要性。
