Lenartowicz Karina A, Murthy Nikhil K, Desy Nicholas M, De La Pena Nicole M, Wolf Alexandre S, Wilson Thomas J, Amrami Kimberly K, Spinner Robert J
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Acta Neurochir (Wien). 2022 Oct;164(10):2689-2698. doi: 10.1007/s00701-022-05311-w. Epub 2022 Jul 25.
The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention.
We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection.
We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases.
We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.
神经内腱鞘囊肿具有动态特性，包括自发扩张和消退，这已被描述。然而，这些囊肿在未经手术治疗的情况下是否能完全消退具有重要的治疗意义。因此，我们旨在回顾关于囊肿在无手术干预情况下消退的文献。
我们查阅了文献中970例神经内腱鞘囊肿的数据库，以寻找基于严格影像学确认的完全消退证据，消退情况包括自发消退、经皮囊肿抽吸或类固醇注射后消退。
我们未发现任何符合纳入标准的未经手术治疗而完全消退的病例。有4例报告了自发消退；然而，只有2例进行了随访成像，两者均显示有残留囊肿。文献中发现19例经皮干预病例，其中13例报告在抽吸/类固醇注射后临床症状改善；然而，只有7例有可用的影像学资料。只有2例报告随访时磁共振成像显示囊肿完全消退，但重新解读发现这两例均有残留的神经内囊肿。
我们认为神经内腱鞘囊肿起源关节处的病理改变（结构异常和/或关节液增多）始终存在，即使囊肿消退也依然存在。囊膜异常或缺损的持续存在可能导致囊肿未来复发，虽然影像学检查可能显示囊肿大小显著减小，但对图像进行真正仔细的评估会发现在关节起源处仍有微小的持续性神经内囊肿病灶。因此，观察性处理或经皮干预可能导致神经内腱鞘囊肿消退，但不能使其完全消失。
