Peronäusläsion, hervorgerufen durch ein rezidivierendes Ganglion des proximalen Tibiofibulargelenkes - Eine Falldarstellung und Literaturübersicht

Zusammenfassung

Fragestellung/Ziel: Verschiedene Ursachen für eine Kompression des Nervus peronaeus communis sind beschrieben worden. Der Nervus peronaeus ist der Nerv, der am häufigsten von intraneuralen Ganglien betroffen ist, welche durch neurologische Defizite, durch schwierige Diagnostik sowie häufig unvollständige operative Eradikation und dadurch bedingte Rezidive den Behandlungsverlauf erschweren. Material und Methoden: Es wird die Epikrise eines 60-jährigen Patienten mit einem Ganglion des proximalen Tibiofibulargelenkes (PTFG), welches durch Kompression eine Läsion des Nervus peronaeus communis bewirkt hat, vorgestellt. Ergebnisse: Die Symptomatik, Differenzialdiagnosen, Pathogenese, neurologischen und radiologischen Befunde, Behandlungsmethoden, Histologie und vorhandene wissenschaftliche Literatur werden diskutiert. Im dargestellten Fall kam es trotz zweimaliger vollständiger intraoperativer Ganglionexzision zu einem erneuten Rezidiv. Der Erkrankungszeitraum betrug bei der letzten Nachuntersuchung zwölf Jahre und zeigte klinisch eine komplette Peronäusparese. Schlussfolgerung: Ganglien des PTFG neigen nach chirurgischer Resektion zu Rezidiven. Deshalb sollte die enge Lagebeziehung eines Ganglions zum PTFG an eine existierende Gelenk-Ganglion-Verbindung denken lassen und somit zu einer sorgfältigen und exakten radiologischen präoperativen Diagnostik mit nachfolgend intraoperativer Suche und vollständiger Resektion dieser Gelenkverbindung führen.

Abstract

Purpose/Background: Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete. Material and Methods: We report a case of a 60-year-old man with peroneal nerve palsy caused by recurrent proximal tibiofibular joint ganglion. Results: Within the context of the current literature, clinical symptoms, diagnostics, differential diagnosis with regard to imaging methods, neurology, pathology and the broader spectrum of operative and non-operative treatment are discussed. The cyst was completely resected, but a recurrent cyst developed eight years later. At reoperation, a communication of the cyst with the tibiofibular joint was demonstrated. Despite complete resection of the cyst and ligation of the ganglion stem, a routine postoperative MRI disclosed a second recurrence of the cyst nine months later. On the last clinical examination, twelve years after onset of the symptoms, a complete paresis of the peroneal nerve was seen. Conclusion: This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.

Schlüsselwörter

Peronäusläsion - proximales tibiofibulares Gelenkganglion - Differenzialdiagnosen - Rezidiv - Behandlung

Key words

Peroneal nerve palsy - proximal tibiofibular joint ganglion - differential diagnosis - recurrence - treatment

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