Department of Orthopaedics, University of Patras, School of Medicine, Patras, Greece.
Department of Orthopaedics, Asklipieio Voulas, Athens, Greece.
Eur J Orthop Surg Traumatol. 2021 Dec;31(8):1639-1645. doi: 10.1007/s00590-021-02903-7. Epub 2021 Mar 2.
Intraneural ganglion cysts of the peroneal nerve are rare, and there is lack of evidence for the surgical management of this entity. We performed this study to evaluate the imaging, diagnosis, treatment and outcome of seven patients with intraneural ganglion cysts of the peroneal nerve.
We retrospectively studied the files of seven patients with intraneural ganglion cysts of the peroneal nerve, diagnosed and treated from 2016 to 2019. Diagnostic approach included clinical examination of the leg and foot, magnetic resonance imaging, nerve conduction studies, surgical excision of the cyst and histological examination. The mean follow-up was 2 years (range 1-3.5 years). We evaluated the time and methods for surgical treatment, and the clinical outcomes of the patients.
All patients presented symptoms of peripheral compression neuropathy; three patients presented with foot drop. The intraneural ganglion cysts were excised in all cases in addition to knee articular nerve branch transection to avoid cysts recurrence. Postoperatively, all patients experienced complete neurological recovery without clinical evidence of intraneural ganglion cysts recurrences.
The treating physicians should be aware of intraneural ganglion cysts of the peroneal nerve in patients presenting with limb weakness, sensory deficits at the lateral and anterior side of the leg and foot, paresis or paralysis of the foot and ankle. MR imaging is the imaging modality of choice for a clear and accurate preoperative diagnosis to avoid misdiagnosis and wrong treatment. In case of doubt, these patients should be managed in an orthopedic oncology setting with microsurgery facilities available for complete excision of the intraneural ganglion cyst.
腓总神经内神经节囊肿较为罕见，目前针对该疾病的手术治疗方法仍缺乏相关证据。本研究旨在评估 7 例腓总神经内神经节囊肿患者的影像学表现、诊断、治疗及预后。
我们回顾性研究了 2016 年至 2019 年间诊断并治疗的 7 例腓总神经内神经节囊肿患者的病历资料。诊断方法包括腿部和足部的临床检查、磁共振成像、神经传导研究、囊肿切除术和组织学检查。平均随访时间为 2 年（1-3.5 年）。我们评估了手术治疗的时机和方法，以及患者的临床结果。
所有患者均表现为周围神经压迫性神经病症状；3 例患者出现足下垂。所有病例均切除了神经内神经节囊肿，并同时横断膝关节关节支，以避免囊肿复发。术后所有患者均完全恢复神经功能，无神经内神经节囊肿复发的临床证据。
对于出现腿部无力、腿部和足部外侧及前侧感觉减退、足和踝关节无力或瘫痪的患者，治疗医生应考虑到腓总神经内神经节囊肿的可能。磁共振成像（MRI）是明确和准确术前诊断的首选影像学检查方法，可避免误诊和错误治疗。如果存在疑虑，这些患者应在具备显微外科设备的骨科肿瘤学环境中进行治疗，以便能够完全切除神经内神经节囊肿。
