gms | German Medical Science

Objectives: Peroneal intraneural ganglia are very rare. The hypothesis of origin is that due to tibiofibular arthrosis joint fluid transverses the capsule and tracks along the articular nerve branch of the common peroneal nerve. The liquid flows intraepineurally, using the path of least resistance, leading to dissection and ganglion formation. Typically clinically symptoms include pain, motor weakness, or sensory abnormalities within the distribution of the common peroneal nerve as well as a palpable mass in proximity to the superior tibiofibular joint. Only few literature exist to describe the disease, treatment and outcome. Our object was to collect the few cases operated in our institution and analyze them.

Methods: The prospective case study included from 2003 to 2016 15 patients suffering from an intraneural common peroneal nerve ganglion. All of whom received nerve decompression. Additionally in 9 patients the articular nerve branch was resected and in 3 cases proximal tibiofibular arthrodesis was performed. The average follow up was 11.6 months evaluating pain, sensory and motoric function.Additionally ENMG examination was performed pre- and postoperatively.

Results and conclusion: 13 patients showed clinical improvement within 8 weeks. At the final follow-up the average VAS score was 0.46 with muscle power over 4 after the MRC muscle scale and paresthesia in 9 patients.

2 patients suffering from cyst recurrence were revised. In both cases the articular branch of the peroneal nerve was not resected. After revision surgery the cyst persisted in one patient, who was finally treated with tibiofibular arthrodesis.

In peroneal nerve ganglia resection of the articular branch is recommended. With additional tibiofibular joint instability arthrodesis should be performed.