Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2019 Jun;126:e259-e269. doi: 10.1016/j.wneu.2019.02.029. Epub 2019 Feb 22.
Intraneural ganglion cysts of the obturator nerve are rare. Our aim is to review cases of obturator intraneural ganglion cysts at our institution and those reported in the literature.
We reviewed all cases evaluated by the senior author. A literature search was performed using the PubMed database and Google Scholar with the following terms: "obturator cyst," "obturator intraneural ganglion cyst," and "obturator intraneural ganglia." All cases underwent a retrospective review. Patient demographic data, including age, sex, and presenting signs and symptoms were recorded. Imaging studies were re-evaluated by 2 musculoskeletal radiologists experienced in the diagnosis of intraneural ganglion cysts.
We identified 2 cases of obturator intraneural ganglia at our institution; both were connected to the hip joint. We found 4 cases that were clearly diagnosed as intraneural ganglia in the literature, of which only 1 was recognized by the original authors as being joint connected, but based on our reinterpretation, 3 of 4 were joint connected. An additional 9 cases identified in the literature did not definitely report the nerve-cyst relationship, but based on our reinterpretation, were believed to be intraneural; 8 were joint connected.
We believe that obturator intraneural ganglion cysts adhere to the principles of the unifying articular theory. They arise from the anteromedial hip joint and extend into an articular branch and can reach the parent obturator nerve. Surgery should address the hip disease and/or the articular branch connection. Not appreciating the pathoanatomy of these cysts can lead to persistent or recurrent cysts.
闭孔神经内神经节囊肿较为罕见。我们旨在回顾本机构的闭孔神经内神经节囊肿病例，并对文献中的病例进行回顾。
我们回顾了由资深作者评估的所有病例。使用 PubMed 数据库和 Google Scholar 进行文献检索，使用以下术语：“闭孔囊肿”、“闭孔内神经节囊肿”和“闭孔内神经节”。所有病例均进行回顾性分析。记录患者的人口统计学数据，包括年龄、性别以及主要症状和体征。2 位具有诊断神经内神经节囊肿经验的肌肉骨骼放射科医生重新评估了影像学研究。
我们在本机构发现 2 例闭孔内神经节，均与髋关节相连。我们在文献中发现了 4 例明确诊断为神经内神经节的病例，其中仅 1 例被原作者认为与关节相连，但根据我们的重新解读，4 例中有 3 例与关节相连。文献中还另外发现了 9 例未明确报告神经-囊肿关系的病例，但根据我们的重新解读，这些病例被认为是神经内的，其中 8 例与关节相连。
我们认为闭孔内神经节囊肿符合关节统一理论的原则。它们起源于髋关节的前内侧，延伸至关节分支，并可到达母体闭孔神经。手术应解决髋关节疾病和/或关节分支连接问题。不了解这些囊肿的病理解剖结构可能导致囊肿持续或复发。
