Peroneal intraneural ganglia: the importance of the articular branch. Clinical series
Peroneal intraneural ganglia: the importance of the articular branch. Clinical series
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DOI：
10.3171/jns.2003.99.2.0319
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发表时间：
2003-08-01
影响因子：
4.1
通讯作者：
Tiel, RL
中科院分区：
文献类型：
--
作者：
Spinner, RJ;Atkinson, JLD;Tiel, RL
目的。腓神经是神经内神经节最常见的部位。与这些囊肿相关的神经功能缺损通常很严重，并且根除它们的手术很困难。这项多中心研究的目的是整理作者对相对罕见病变的经验，并通过更好地了解其有争议的发病机制来改善临床结果。方法。本文第一部分描述了 24 名患有腓神经内神经节的患者，外科医生意识到腓神经关节支的重要性，对这些患者进行了治疗。第二部分描述了另外三名患者，这些患者在早期手术后接受了神经节切除，但关节分支尚未确定（据报道，全部切除）。 27 名患者中，有 26 名患者出现腓总神经 (CPN) 病变的临床、电生理学和影像学证据，主要影响腓深神经 (DPN) 分支，一名患者出现 CPN 疼痛性肿块，但不伴有神经功能缺损。在第一部分的所有 24 名患者中，磁共振 (MR) 成像证据表明囊肿与上胫腓关节之间有联系，其中一名患者的高分辨率(3-特斯拉) MR 神经造影显示了病理性关节分支本身。在手术中，事实证明，在所有情况下，通信都通过 CPN 的关节分支延伸。手术包括囊肿引流和关节支结扎。在最短一年的随访期内，这些患者的神经性疼痛得到了显着改善，但功能缺陷仅得到了轻微改善。 24 名患者均未发现神经内复发的证据。然而，在三名患者中，出现了神经外神经节：两名有症状的患者随后接受了上胫腓关节切除术，没有进一步复发，一名无症状的患者在术后 1 年影像学中偶然发现复发后进行了临床随访。正如预测的那样，在第二部分中，所有三名未结扎关节支的患者都经历了早期神经内复发；术后 MR 图像和原始研究进行回顾性检查，均证明与上胫腓关节有关。结论。腓神经内神经节的临床表现、电学研究、影像学特征和手术观察是可预测的。治疗必须解决潜在的病理解剖学问题，包括囊肿减压和神经关节支结扎。为了避免神经外复发，也可能需要切除上胫腓关节，但需要确定这一额外手术的适应症。这些建议基于作者的信念，即神经内腓神经节起源于上胫腓关节，并通过关节分支与之相连。
Object. The peroneal nerve is the most common site of intraneural ganglia. The neurological deficit associated with these cysts is often severe and the operation to eradicate them is difficult. The aims of this multicenter study were to collate the authors' experience with a relatively rare lesion and to improve clinical outcomes by better understanding its controversial pathogenesis.Methods. Part I of this paper offers a description of 24 patients with peroneal intraneural ganglia who were treated by surgeons aware of the importance of the peroneal nerve's articular branch. Part II offers a description of three more patients who were seen after earlier operations in which the ganglion was excised, but the articular branch was not identified (all reportedly gross-total resections). Twenty-six of the 27 patients presented with clinical, electrophysiological, and imaging evidence of a common peroneal nerve (CPN) lesion, predominantly affecting the deep peroneal nerve (DPN) division, and one patient presented with a painful mass of the CPN that was not accompanied by a neurological deficit.In all 24 patients in Part I there was magnetic resonance (MR) imaging evidence of a connection between the cyst and the superior tibiofibular joint, including one patient in whom high-resolution (3-tesla) MR neurography demonstrated the pathological articular branch itself. At the operation, the communication proved to extend through the articular branch of the CPN in all cases. The operation consisted of drainage of the cyst and ligation of the articular branch. At a minimum follow-up period of 1 year, these patients experienced significant improvements in their neuropathic pain, but only mild improvements in their functional deficits. In none of the 24 patients was there evidence of an intraneural recurrence. In three patients, however, extraneural ganglia developed: two patients with symptoms subsequently underwent resection of the superior tibiofibular joint without further recurrence and one patient with no symptoms was followed clinically after the recurrence was detected incidentally on 1-year postoperative imaging. As predicted, in Part II all three patients in whom the articular branch had not been ligated experienced early intraneural recurrence; both postoperative MR images and original studies, which were retrospectively examined, demonstrated a connection with the superior tibiofibular joint.Conclusions. The clinical presentation, electrical studies, imaging characteristics, and operative observations regarding peroneal intraneural ganglia are predictable. Treatment must address the underlying pathoanatomy and should include decompression of the cyst and ligation of the articular branch of the nerve. To avoid extraneural recurrence, resection of the superior tibiofibular joint may also be necessary, but indications for this additional procedure need to be defined. These recommendations are based on the authors' belief that intraneural peroneal ganglia arise from the superior tibiofibular joint and are connected to it by the articular branch.