Artikel
Intraneural ganglia – diagnosis and treatment options for this rare nerve lesion
Intraneurale Ganglien – Diagnostik und Behandlungsoptionen dieses seltenen Krankheitsbildes
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Veröffentlicht: | 30. Mai 2008 |
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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.