Department of Neurosurgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Acta Neurochir (Wien). 2019 Oct;161(10):2129-2132. doi: 10.1007/s00701-019-04027-8. Epub 2019 Aug 6.
Intraneural ganglion cysts in the tarsal tunnel are rare but are being increasingly reported. The cysts involve the tibial or plantar nerves and are most commonly derived from a neighboring (degenerative) joint, (i.e., the tibiotalar or subtalar) via an articular branch arising from the medial aspect of the nerve. We describe a safe zone for approaching these cysts in the tarsal tunnel that allows for identification of the joint connection without injury to important distal branches.
We present a case of an intraneural ganglion cyst within the tarsal tunnel in a patient with symptoms consistent with tarsal tunnel syndrome. Using intraoperative photographs and artist rendering, we describe a technique to safely disconnect the abnormal joint connection while preserving the important distal branches of the tibial nerve.
The safe zone for the tibial nerve in the tarsal tunnel can be exposed by mobilization and gentle retraction of the vascular bundle. In cases of intraneural ganglion cysts, all apparent connections between the nerve and degenerative joints within this safe zone can be resected without injury to important distal nerve branches.
跗管内神经鞘瘤囊肿较为罕见，但报道越来越多。这些囊肿涉及胫神经或足底神经，最常见的来源是邻近的（退行性）关节，（即距下关节或跗中关节）通过从神经内侧发出的关节支。我们描述了一种在跗管中接近这些囊肿的安全区域，该区域可在不损伤重要的远端分支的情况下识别关节连接。
我们介绍了一例患者在跗管内神经鞘瘤囊肿的病例，该患者的症状与跗管综合征一致。我们使用术中照片和艺术家渲染，描述了一种安全地断开异常关节连接而不损伤胫神经重要远端分支的技术。
通过血管束的移位和轻柔的牵拉，可以暴露跗管内胫神经的安全区域。在神经内神经鞘瘤囊肿的情况下，可以切除该安全区内所有神经与退行性关节之间的明显连接，而不会损伤重要的远端神经分支。
