Download PDF
CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e33-e36
DOI: 10.1055/s-0042-1742608
Case Report

Intraneural Ganglion of the Peroneal Nerve—A Rare Cause of Pediatric Peroneal Nerve Palsy: A Case Report

Florian Bucher
1   Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
,
Vincent Maerz
1   Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
,
Doha Obed
1   Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
,
Peter M. Vogt
2   Medizinische Hochschule Hannover - Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Hannover, Germany
,
Birgit Weyand
1   Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Intraneural ganglia are benign mucinous cysts located within the epineurium of a peripheral nerve. The pathogenesis and formation of intraneural ganglia are controversial. The main theories described in the literature are of degenerative, synovial or de novo occurrence. We present the case of a 14-year-old boy who presented in our outpatient clinic with a complaint of interdigital neuralgia between hallux and second toe, as well as left foot drop. MRI examination showed a hyperintense cystic distension of the common peroneal nerve measuring 130 mm × 5 mm extending from the poplitea to the anterior compartment of the leg. We performed microscopic decompression and neurolysis surgery. The cyst showed a sac-like distension at its distal end with connection to the tibiofibular joint and was resected. After 8 weeks, postoperatively, the boy claimed to be pain-free and slight recovery of the superficial peroneal nerve was noticed. At 6 months postoperative, the patient showed a continuous improvement of motor function, demonstrating foot eversion with 3/5 muscle strength and foot extension with 2/5 muscle strength. Intraneural ganglia reported for pediatric patients represent a very rare entity. To the best of our knowledge, less than 15 cases have been described within the English-speaking literature.

Keywords

intraneural ganglion - peripheral neuropathy - peroneal nerve palsy


Publication History

Received: 01 June 2021

Accepted: 23 November 2021

Article published online:
10 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Panwar J, Mathew A, Thomas BP. Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?. World J Radiol 2017; 9 (05) 230-244
    CrossrefPubMedSearch in Google Scholar
  • 2 Wilson TJ, Mauermann ML, Rock MG, Spinner RJ. Outcomes following surgery for peroneal intraneural ganglion cysts. Muscle Nerve 2018; 57 (06) 989-993
    CrossrefPubMedSearch in Google Scholar
  • 3 Spinner RJ, Atkinson JL, Scheithauer BW. et al. Peroneal intraneural ganglia: the importance of the articular branch. Clinical series. J Neurosurg 2003; 99 (02) 319-329
    CrossrefPubMedSearch in Google Scholar
  • 4 Spinner RJ, Amrami KK, Wolanskyj AP. et al. Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg 2007; 107 (02) 296-307
    CrossrefPubMedSearch in Google Scholar
  • 5 Akcakaya MO, Shapira Y, Rochkind S. Peroneal and tibial intraneural ganglion cysts in children. Pediatr Neurosurg 2013; 49 (06) 347-352
    CrossrefPubMedSearch in Google Scholar
  • 6 Luigetti M, Sabatelli M, Montano N, Cianfoni A, Fernandez E, Lo Monaco M. Teaching neuroimages: peroneal intraneural ganglion cyst: a rare cause of drop foot in a child. Neurology 2012; 78 (07) e46-e47
    CrossrefPubMedSearch in Google Scholar
  • 7 Wu P, Xu S, Cheng B. et al. Surgical treatment of intraneural ganglion cysts of the ulnar nerve at the elbow: long-term follow-up of 9 cases. Neurosurgery 2019; 85 (06) E1068-E1075
    CrossrefPubMedSearch in Google Scholar
  • 8 Poage C, Roth C, Scott B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg 2016; 24 (01) 1-10
    CrossrefPubMedSearch in Google Scholar
  • 9 Carolus AE, Becker M, Cuny J, Smektala R, Schmieder K, Brenke C. The interdisciplinary management of foot drop. Dtsch Arztebl Int 2019; 116 (20) 347-354
    CrossrefPubMedSearch in Google Scholar
  • 10 Srinivasan J, Ryan MM, Escolar DM, Darras B, Jones HR. Pediatric sciatic neuropathies: a 30-year prospective study. Neurology 2011; 76 (11) 976-980
    CrossrefPubMedSearch in Google Scholar
  • 11 Spinner RJ, Carmichael SW, Wang H, Parisi TJ, Skinner JA, Amrami KK. Patterns of intraneural ganglion cyst descent. Clin Anat 2008; 21 (03) 233-245
    CrossrefPubMedSearch in Google Scholar
  • 12 Spinner RJ, Scheithauer BW, Amrami KK. The unifying articular (synovial) origin of intraneural ganglia: evolution-revelation-revolution. Neurosurgery 2009; 65 (4, suppl): A115-A124
    CrossrefPubMedSearch in Google Scholar
  • 13 Desy NM, Wang H, Elshiekh MA. et al. Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 2016; 125 (03) 615-630
    CrossrefPubMedSearch in Google Scholar
  • 14 Consales A, Pacetti M, Imperato A, Valle M, Cama A. Intraneural ganglia of the common peroneal nerve in children: case report and review of the literature. World Neurosurg 2016; 86: 510.e11-510.e17 , E17
    CrossrefPubMedSearch in Google Scholar
  • 15 Spinner RJ, Desy NM, Rock MG, Amrami KK. Peroneal intraneural ganglia. Part I. Techniques for successful diagnosis and treatment. Neurosurg Focus 2007; 22 (06) E16
    PubMedSearch in Google Scholar
  • 16 Lateur G, Pailhé R, Refaie R. et al. Ganglion cysts of the proximal tibiofibular articulation: the role of arthrodesis and combined partial fibula excision. Int Orthop 2018; 42 (06) 1233-1239
    CrossrefPubMedSearch in Google Scholar