Lenartowicz Karina A, Amrami Kimberly K, Spinner Robert J
1Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota; and.
Departments of2Radiology and.
J Neurosurg Case Lessons. 2023 Feb 13;5(7). doi: 10.3171/CASE22572.
The articular (synovial) theory describes the formation of intraneural ganglion cysts through defects in the capsule of synovial joints. While the articular theory is gaining significant traction in the literature, it is not universally accepted. Therefore, the authors present a case of a plainly visible peroneal intraneural cyst, although the subtle joint connection was not identified specifically at the time of surgery, with subsequent rapid extraneural cyst recurrence. The joint connection was not immediately evident on review of the magnetic resonance imaging, even to the authors who have a large experience with this clinical entity. The authors report this case to demonstrate that all intraneural ganglion cysts have joint connections, although they may be difficult to identify.
An occult joint connection in the intraneural ganglion poses a unique diagnostic and management dilemma. High-resolution imaging is a valuable tool used to identify the articular branch joint connection as part of the surgical planning.
Based on the articular theory, all intraneural ganglion cysts will have a joint connection through an articular branch, although this may be small or nearly invisible. Failure to appreciate this connection can lead to cyst recurrence. A high index of suspicion of the articular branch is needed for surgical planning.
关节（滑膜）理论描述了神经内腱鞘囊肿通过滑膜关节囊的缺损形成。虽然关节理论在文献中越来越受到关注，但尚未被普遍接受。因此，作者报告了一例明显可见的腓总神经内囊肿病例，尽管在手术时未明确发现细微的关节连接，随后囊肿迅速复发至神经外。即使是对该临床实体有丰富经验的作者，在回顾磁共振成像时，关节连接也并非立即明显可见。作者报告此病例以证明所有神经内腱鞘囊肿都有关节连接，尽管可能难以识别。
神经内腱鞘囊肿中隐匿的关节连接带来了独特的诊断和管理难题。高分辨率成像作为手术规划的一部分，是用于识别关节分支连接的重要工具。
基于关节理论，所有神经内腱鞘囊肿都将通过关节分支存在关节连接，尽管这种连接可能很小或几乎不可见。未能认识到这种连接可能导致囊肿复发。手术规划时需要对关节分支保持高度怀疑。
