Leafblad Nels D, Wilson Thomas J, Amrami Kimberly K, Turner Norman S, Spinner Robert J
Resident, Department of Orthopedics, Mayo Clinic, Rochester, MN.
Fellow, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
J Foot Ankle Surg. 2019 Mar;58(2):377-380. doi: 10.1053/j.jfas.2018.08.044. Epub 2019 Jan 3.
Soft tissue ganglion cysts are a well-known cause of tibial nerve compression in the tarsal tunnel. We describe a patient who presented with tibial nerve symptoms and was found to have an adventitial cyst of the tibial vein arising from the subtalar joint, with the joint connection confirmed both on imaging and at surgery. Surgical decompression of the cyst with transection of the vascular pedicle arising from the subtalar joint improved her symptoms at 6 months, and postoperative magnetic resonance imaging showed resolution of the cyst. Cystic adventitial disease is a rare, poorly understood condition in which a cyst is identified in the adventitia of a vessel, usually an artery. Only 3 cases of adventitial cysts have been reported in the foot and ankle region, 2 in the lesser and 1 in the greater saphenous vein. None of the previous cases have been recognized to be joint connected. This case provides additional evidence for an articular origin for adventitial cysts and helps guide management strategies for these joint-connected cysts.
软组织腱鞘囊肿是跗管内胫神经受压的常见原因。我们描述了一名出现胫神经症状的患者，发现其距下关节处的胫静脉有一个外膜囊肿，影像学和手术均证实了囊肿与关节的连接。通过切断距下关节发出的血管蒂对囊肿进行手术减压，6个月时患者症状改善，术后磁共振成像显示囊肿消失。囊性外膜病是一种罕见且了解甚少的疾病，其中在血管（通常是动脉）的外膜中发现囊肿。足部和踝部区域仅报道过3例外膜囊肿，2例位于小隐静脉，1例位于大隐静脉。之前的病例均未被认为与关节相连。该病例为外膜囊肿的关节起源提供了额外证据，并有助于指导这些与关节相连囊肿的管理策略。
