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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Intraneural ganglia – diagnosis and treatment options for this rare nerve lesion

Intraneurale Ganglien – Diagnostik und Behandlungsoptionen dieses seltenen Krankheitsbildes

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  • corresponding author U.M. Bäzner - Abteilung für Neurochirurgie, Universität Ulm/Günzburg
  • H. P. Richter - Abteilung für Neurochirurgie, Universität Ulm/Günzburg
  • G. Antoniadis - Abteilung für Neurochirurgie, Universität Ulm/Günzburg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.08.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc200.shtml

Published: May 30, 2008

© 2008 Bäzner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Intraneural ganglia are rare non-neoplastic cysts in the epineurium of peripheral nerves – most common in the peroneal nerve.

The neurological deficits associated with the cysts are often severe; so it is important to optimize the clinical outcome by understanding the pathogenesis of this rare entity.

Methods: In our department 9 patients underwent surgery between January 2000 and June 2007 (8 peroneal nerves and 1 tibial nerve). Frequently an acute footdrop is the chief symptom, here in 7 out of 9 patients. 6 out of 9 cases complained of pain and paresthesias on the shin or lateral malleolar area. A Tinel's sign was present in all cases. All patients presented with electrophysiological studies and MRI including typical findings such as a signet sign. A transverse limb sign and/or a tail sign were found in all patients.

Results: Intraoperatively, intraneural ganglia of the peroneal nerve followed the course of the articular branch with a connection to the tibiofibular joint (tibial nerve – talocalcaneal joint). Surgery consisted of epineurectomy, drainage of the cyst and ligation of the articular branch. After a minimum follow-up period of 1 year, all patients reported significant improvements in the motor deficits up to 4 grades MRC. Sensory deficits remained nearly unchanged. In 3 out of 9 patients MR imaging evidence of an intraneural recurrence was found after 6 months; two of them underwent a reoperation.

Conclusions: To avoid high recurrence rates, it is important to understand the pathogenesis of these lesions. The intraneural ganglia are joint-related and so the ligation of the articular branch is essential for the success of the operation.

Significant pain reduction and a functional improvement of the neurological deficits can be achieved.