Mayer Savannah L, Grewal Jagmeet S, Gloe Tyler, Khasho Catherine A, Harder Steven
Family Medicine, Des Moines University, Des Moines, USA.
Cureus. 2021 Feb 26;13(2):e13570. doi: 10.7759/cureus.13570.
Intraneural ganglion cysts are a rare occurrence. They are most commonly found originating from the common peroneal nerve but are also frequently reported on the radial, ulnar, median, sciatic, tibial, and posterior interosseous nerves. A typical clinical presentation is posterior knee and calf pain resulting from tibial neuropathy with preferential degeneration of the popliteus muscle. Symptoms include pain, paresthesias, and decreased strength that originates in the knee and commonly extends to the plantar surface of the foot. These findings can be mistaken for lumbar neuropathies and compression of the sacral nerve roots. Differential diagnosis includes peripheral nerve sheath tumors, Baker's cysts, extraneural ganglion cysts, and atypical vascular or lymphatic malformations. In this case report, the patient was a 61-year-old male, previously in good health, who presented with progressive pain in his medial left hamstring as well as weakness in left foot plantar flexion and paresthesias in the plantar aspect of his left foot. He first noticed impairments with his ability to push off with his left foot when running. His electromyogram (EMG) was abnormal and subsequent MRI of the left leg showed a complex intraneural ganglion cyst arising from the tibiofibular joint and ascending into the tibial nerve. He underwent indirect decompression through joint resection. Unfortunately, he did not have clinical improvement on one-year follow-up. Overall, symptomatic treatment of intraneural ganglion cyst includes decompression, surgical excision, or minimally invasive decompression by percutaneous aspiration of the ganglion under ultrasound guidance.
神经内腱鞘囊肿较为罕见。它们最常起源于腓总神经，但也经常在桡神经、尺神经、正中神经、坐骨神经、胫神经和骨间后神经上被报道。典型的临床表现是由胫神经病变导致的腘绳肌优先退变引起的膝后部和小腿疼痛。症状包括疼痛、感觉异常以及始于膝盖并通常延伸至足底的力量减弱。这些表现可能被误诊为腰椎神经病变和骶神经根受压。鉴别诊断包括周围神经鞘瘤、贝克囊肿、神经外腱鞘囊肿以及非典型血管或淋巴管畸形。在本病例报告中，患者为一名61岁男性，既往身体健康，出现左侧腘绳肌内侧渐进性疼痛、左足跖屈无力以及左足底感觉异常。他最初注意到跑步时用左脚蹬地的能力受损。他的肌电图（EMG）异常，随后左腿的MRI显示一个复杂的神经内腱鞘囊肿起源于胫腓关节并向上延伸至胫神经。他接受了通过关节切除进行的间接减压。不幸的是，一年随访时他的临床症状并未改善。总体而言，神经内腱鞘囊肿的对症治疗包括减压、手术切除或在超声引导下经皮抽吸腱鞘囊肿进行微创减压。
