Cross-over: A generalizable phenomenon necessary for secondary intraneural ganglion cyst formation
Cross-over: A generalizable phenomenon necessary for secondary intraneural ganglion cyst formation
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DOI：
10.1002/ca.20590
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发表时间：
2008-03-01
期刊：
影响因子：
2.4
通讯作者：
Carmichael, Stephen W.
中科院分区：
文献类型：
--
作者：
Spinner, Robert J.;Amrami, Kimberly K.;Carmichael, Stephen W.
神经内腱鞘囊肿的外观正在阐明。我们之前介绍了交叉现象来解释腓骨（腓骨）或胫骨神经内腱鞘囊肿起源于上级胫腓关节，可引起多发性囊肿：囊液沿原患神经上行，可达坐骨神经水平，充满坐骨神经外膜鞘，扩张周围神经（交叉），此时压力通量可能导致坐骨神经进一步上升或下降到相同的母神经或相反的先前未受影响的腓神经或胫神经。在这项研究中，我们假设交叉可能发生在其他神经，可能导致形成一个以上的神经内腱鞘囊肿在这种情况下。我们分析了文献，并确定了一个单一的情况下，我们可以审查，近端延伸的神经内腱鞘囊肿涉及神经在不同的网站，理论上可以经历交叉在另一个主要神经足够大的可用磁共振图像来解决这个问题。我们的研究小组先前报告了一个肩胛上神经内腱鞘囊肿的病例，该囊肿起源于盂肱关节并延伸到颈部，我们重新分析了是否存在交叉。在新鲜尸体标本中，将染料注射到肩胛上神经的外膜中，以测试实验上的交叉。对该肩胛上神经内腱鞘囊肿病例的回顾性分析显示，有证据支持先前未被识别的上干水平交叉，主要向上上升至C5和C6神经根，向下轻微下降至上干的前、后分支以及肩胛上神经的近端部分。这种外观引起了多个相互联系的神经内腱鞘囊肿产生于一个单一的远端连接到盂肱关节。注射研究也证明了交叉现象，并产生了与囊肿剥离相似的模式。这篇文章说明，交叉可以发生在另一个神经（除了原型腓神经）。此外，了解上干交叉模型的更复杂的解剖性质提供了关于双向传播模式和形成原发性和继发性神经内腱鞘囊肿的重要机制信息的洞察力，而这些信息是先前描述的坐骨神经交叉模型所不能提供的。
The appearances of intraneural ganglion cysts are being elucidated. We previously introduced the cross-over phenomenon to explain how a fibular (peroneal) or tibial intraneural ganglion cyst arising from the superior tibiofibular joint could give rise to multiple cysts: cyst fluid ascending up the primarily affected nerve could reach the level of the sciatic nerve, fill its common epineurial sheath and spread circurnferentially (cross over), at which time pressure fluxes could result in further ascent up the sciatic or descent down the same parent nerve or the opposite, previously unaffected fibular or tibial nerves. In this study, we hypothesized that cross-over could occur in other nerves, potentially leading to the formation of more than one intraneural ganglion cyst in such situations. We analyzed the literature and identified a single case that we could review where proximal extension of an intraneural ganglion cyst involving a nerve at a different site could theoretically undergo cross-over in another major nerve large enough for available magnetic resonance images to resolve this finding. A case of a suprascapular intraneural ganglion cyst previously reported by our group that arose from the glenohumeral joint and extended to the neck was reanalyzed for the presence or absence of crossover. An injection of dye into the outer epineurium of the suprascapular nerve in a fresh cadaveric specimen was performed to test for cross-over experimentally. Retrospective review of this case of suprascapular intraneural ganglion cyst demonstrated evidence to support previously unrecognized cross-over at the level of the upper trunk, with predominant ascent up the C5 and the C6 nerve roots and subtle descent down the anterior and posterior divisions of the upper trunk as well as the proximal portion of the suprascapular nerve. This appearance gave rise to multiple interconnected intraneural ganglion cysts arising from a single distant connection to the glenohumeral joint. The injection study also demonstrated the cross-over phenomenon and produced a similar pattern as the cyst dissection. This article illustrates that cross-over can occur in another nerve (apart from the prototype fibular nerve). Furthermore, understanding the more complex anatomic nature of the upper trunk crossover model provides insight into important mechanistic information regarding the bidirectional propagation patterns and formation of primary and secondary intraneural ganglion cysts not afforded by the previously described sciatic nerve cross-over model.