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.

Peronäusläsion - proximales tibiofibulares Gelenkganglion - Differenzialdiagnosen - Rezidiv - Behandlung

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

Literatur

• 1 Antonini G, Bastianello S, Nucci F, Artico M, Bozzao L, Millefiorini M. Ganglion of deep peroneal nerve: electrophysiology and CT scan in the diagnosis.  Electromyogr Clin Neurophysiol. 1991;  31 9-13
• 2 Aulisa L, Tamburelli F, Padua R, Lupparelli S, Tonali P, Padua L. Intraneural cyst of the peroneal nerve.  Child's Nerv Syst. 1998;  14 222-225
• 3 Barrett R, Cramer F. Tumors of the peripheral nerves and so-called “ganglia” of the peroneal nerve.  Clin Orthop. 1963;  27 135-146
• 4 Barrie H J, Barrington T W, Colwill J C, Simmons E H. Ganglion migrans of the proximal tibiofibular joint causing lesions in the subcutaneous tissue, muscle, bone or peroneal nerve: Report of three cases and review of the literature.  Clin Orthop. 1980;  149 211-215
• 5 Barth H, Sehl U. Intraneurales Ganglion des Nervus peronaeus.  Zentralbl Chir. 1987;  112 1055-1059
• 6 Bianchi S, Abdelwahab I F, Kenan S, Zwass A, Ricci G, Palomba G. Intramuscular ganglia arising from the superior tibiofibular joint: CT and MR evaluation.  Skeletal Radiol. 1995;  24 253-256
• 7 Borrero F, Helbig B. Zum intraneuralen Ganglion des N. peronaeus communis. Ein Fallbericht.  Z Orthop. 1984;  122 198-200
• 8 Bowker J H, Olin F H. Complete replacement of the peroneus longus muscle by a ganglion with compression of the peroneal nerve: A case report.  Clin Orthop. 1979;  140 172-174
• 9 Bozkurt M, Yilmaz E, Atlihan D, Tekdemir I, Havitçioğlu H, Günal I. The proximal tibiofibular joint: An anatomic study.  Clin Orthop. 2003;  406 136-140
• 10 Brooks D M. Nerve compression by simple ganglia.  J Bone Joint Surg [Br]. 1952;  34 391-400
• 11 Burk D L, Dalinka M K, Kanal E, Schiebler M L, Cohen E K, Prorok R J, Gefter W B, Kressel H Y. Meniscal and ganglion cysts of the knee: MR evaluation.  AJR. 1988;  150 331-336
• 12 Ciucci G, Callegarini C, Stumpo M, Poppi M. Ganglionic cyst of the deep peroneal nerve: Description of a case.  Ital J Neurol Sci. 1996;  17 83-86
• 13 Clark K. Ganglion of the lateral popliteal nerve.  J Bone Joint Surg [Br]. 1961;  43 778-783
• 14 Coakley F V, Finlay D B, Harper W M, Allen M J. Direct and indirect MRI findings in ganglion cysts of the common peroneal nerve.  Clin Radiol. 1995;  50 168-169
• 15 Cobb C A, Moiel R H. Ganglion of the peroneal nerve. Report of two cases.  J Neurosurg. 1974;  41 255-259
• 16 Coleman S H, Beredjeklian P K, Weiland A J. Intraneural ganglion cyst of the peroneal nerve accompanied by complete foot drop. A case report.  Am J Sports Med. 2001;  29 238-241
• 17 Crane A R, Scarano J J. Synovial cysts (ganglia) of bone. Report of two cases.  J Bone Joint Surg [Am]. 1967;  49 355-361
• 18 Damron T A, Rock M G. Unusual manifestations of proximal tibiofibular joint synovial cysts.  Orthopedics. 1997;  20 225-230
• 19 De Maeseneer M, De Boeck H, Shahabpour M, Hoorens A, Oosterlinck D, Van Tiggelen R. Subperiosteal ganglion cyst of the tibia. A communication with the knee demonstrated by delayed arthrography.  J Bone Joint Surg [Br]. 1999;  81 643-646
• 20 De Schrijver F, Simon J P, De Smet L, Fabry G. Ganglia of the superior tibiofibular joint: Report of three cases and review of the literature.  Acta Orthop Belg. 1998;  64 233-241
• 21 Dubuisson A S, Stevenaert A. Recurrent ganglion cyst of the peroneal nerve: Radiological and operative observations.  J Neurosurg. 1996;  84 280-283
• 22 Edwards M SD, Hirigoyen M, Burge P D. Compression of the common peroneal nerve by a cyst of the lateral meniscus. A case report.  Clin Orthop. 1995;  316 131-133
• 23 Eiras J, Garcia Cosamalŏn P J. Intraneural ganglion of the common peroneal nerve.  Neurochirurgia. 1979;  22 145-150
• 24 Ellis V H. Two cases of ganglia in the sheath of the peroneal nerve.  Br J Surg. 1936;  24 141-142
• 25 Evans J D, Neumann L, Frostick S P. Compression neuropathy of the common peroneal nerve caused by a ganglion.  Microsurgery. 1994;  15 193-195
• 26 Faivre J, Chatel M, Le Beguec P, Sabouraud O, Jan M, Ramée M P. Les pseudo-kystes mucoïdes de la gaine du nerf sciatique poplité externe.  Rev Neurol (Paris). 1975;  131 709-720
• 27 Fansa H, Plogmeier K, Gonschorek A, Feistner H. Common peroneal nerve palsy caused by a ganglion. Case report.  Scand J Plast Reconstr Hand Surg. 1998;  32 425-427
• 28 Firooznia H, Golimbu C, Rafii M, Chapnick J. Computerized tomography in diagnosis of compression of the common peroneal nerve by ganglion cysts.  Comput Radiol. 1983;  7 343-345
• 29 Fransen P, Thauvoy C, Sindic C JM, Stroobandt G. Intraneural ganglionic cyst of the common peroneal nerve: Case report and review of the literature.  Acta Neurol Belg. 1991;  91 231-235
• 30 Friedlaender H L. Intraneural ganglion of the tibial nerve. A case report.  J Bone Joint Surg [Am]. 1967;  49 519-522
• 31 Gambari P I, Guiliani G, Poppi M, Pozatti E. Ganglionic cysts of the peroneal nerve at the knee: CT and surgical correlation.  J Comput Assist Tomogr. 1990;  14 801-803
• 32 Gayet L E, Morand F, Goujon J M, Pries P, Clarac J P. Compression du nerf sciatique poplité externe par un kyste synovial chez un enfant de 7 ans.  Rev Chir Orthop Reparatrice Appar Mot. 1996;  82 762-766
• 33 Gazzeri G, Santucci N. Le cisti sinoviali intraneurali dello sciatico popliteo esterno: Osservazioni su due casi trattati con tecniche microchirurgiche.  Minerva Chir. 1984;  39 1143-1145
• 34 Ghossain M, Mohasseb G, Dagher F, Ghossain A. Compression du nerf sciatique poplite externe par un kyste synovial.  Neurochirurgie. 1987;  33 412-414
• 35 Gibbon A J, Wardell S R, Scott R D. Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty.  J Arthroplasty. 1999;  14 766-768
• 36 Godin V, Huaux J P, Knoops P, Noel H, Rombouts J J, Stasse P. Une cause rare de paralysie des muscles releveurs du pied: Le kyste synovial intraneural du nerf sciatique poplité externe.  Louvain Med. 1985;  104 281-286
• 37 Gray D J, Gardner E. Prenatal development of the human knee and superior tibiofibular joints.  Am J Anat. 1950;  86 235-287
• 38 Gurdjian E S, Larsen R D, Lindner D W. Intraneural cyst of the peroneal and ulnar nerves. Report of two cases.  J Neurosurg. 1965;  23 76-78
• 39 Harbaugh K S, Tiel R L, Kline D G. Ganglion cyst involvement of peripheral nerves.  J Neurosurg. 1997;  87 403-408
• 40 Ilahi O A, Younas S A, Labbe M R, Edson S B. Prevalence of the ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study.  Arthroscopy. 2003;  19 150-153
• 41 Jacobs R R, Maxwell J A, Kepes J. Ganglia of the nerve. Presentation of two unusual cases, a revue of the literature and a discussion of pathogenesis.  Clin Orthop. 1975;  113 135-144
• 42 Jerome D, McKendry R. Synovial cyst of the proximal tibiofibular joint.  J Rheumatol. 2000;  27 1096-1098
• 43 Kabukçuoglu Y, Kabukçuoglu F, Kuzgun Ü, Öztürk I. Compression neuropathy of the peroneal nerve caused by a ganglion.  Am J Orthop. 1997;  26 700-702
• 44 Kaplan E B. Cyst (ganglion) connected with the proximal tibiofibular joint.  Bull Hosp Joint Dis. 1961;  22 105-107
• 45 Katz M R, Lenobel M I. Intraneural ganglionic cyst of the peroneal nerve. Case report.  J Neurosurg. 1970;  32 692-694
• 46 Kelm J, Ames M, Weißenbach P, Engel C. A ganglion of the superior tibiofibular joint as a mucoid-cystic degeneration of unusual localization.  Knee Surg Sports Traumatol Arthrosc. 1998;  6 62-66
• 47 Kim D H, Murovic J A, Tiel R L, Kline D G. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center.  Neurosurgery. 2004;  54 1421-1429
• 48 Kobayashi H, Kotoura Y, Hosono M, Tsuboyama T, Sakahara H, Konishi J. Periosteal ganglion of the tibia.  Skeletal Radiol. 1996;  25 381-383
• 49 Lagarrigue J, Robert R, Resche F, Sindou M, Lazzerini P. Kystes synoviaux intranerveux du sciatique poplité externe.  Neurochirurgie. 1982;  28 131-134
• 50 Lanz U, Lehmann L, Lurati M. Intraneurales Ganglion des Nervus peronaeus.  Chirurg. 1975;  46 398-399
• 51 Ledderhose G. Die Aetiologie der carpalen Ganglien.  Dtsch Zeitschr Chir. 1893;  37 102-143
• 52 Lee K R, Cox G G, Neff J R, Arnett G R, Murphey M D. Cystic masses of the knee: Arthrographic and CT evaluation.  AJR. 1987;  148 329-334
• 53 Leijten F SS, Arts W F, Puylaert J BCM. Ultrasound diagnosis of an intraneural ganglion cyst of the peroneal nerve. Case report.  J Neurosurg. 1992;  76 538-540
• 54 Lennander K G. Ett stort ganglion pä underbenet.  Upsala Läk Förh. 1891/92;  27 419-425
• 55 Leon J, Marano G. MRI of peroneal nerve entrapment due to a ganglion cyst.  Magn Reson Imaging. 1987;  5 307-309
• 56 Masciocchi C, Innacoli M, Cisternino S, Barile A, Rossi F, Passariello O R. Myxoid intraneural cysts of external popliteal ischiadic nerve. Report of 2 cases studied with ultrasound, computed tomography and magnetic resonance imaging.  Eur J Radiol. 1992;  14 52-55
• 57 Maury F, Migaud H, Cotten A, Hurtevent J F, Flip R M. Intraneural myxoid cyst of the common peroneal nerve. A rare cause of sciatic paralysis.  Rev Rhum (Engl Ed). 1995;  62 534-536
• 58 McEvedy B V. Simple ganglia.  Br J Surg. 1962;  49 585-594
• 59 Meo A, Lucci B. A case of intraneural cyst of the common peroneal nerve.  Ital J Neurol Sci. 1988;  9 607-610
• 60 Miskovsky S, Kaeding C, Weis L. Proximal tibiofibular joint ganglion cysts. Excision, recurrence and joint arthrodesis.  Am J Sports Med. 2004;  32 1022-1028
• 61 Muckart R D. Compression of the common peroneal nerve by intramuscular ganglion from the superior tibio-fibular joint.  J Bone Joint Surg [Br]. 1976;  58 241-244
• 62 Nathan H. Gangliform enlargement on the lateral cutaneous nerve of the thigh. Its significance in the understanding of the etiology of meralgia paresthetica.  J Neurosurg. 1960;  17 843-850
• 63 Nicholson T R, Cohen R C, Grattan-Smith P J. Intraneural ganglion of the common peroneal nerve in a 4-year old boy.  J Child Neurol. 1995;  10 213-215
• 64 Nucci F, Artico M, Santoro A, Bardella L, Delfini R, Bosco S, Palma L. Intraneural synovial cyst of the peroneal nerve: Report of two cases and review of the literature.  Neurosurgery. 1990;  26 339-344
• 65 O'Brien D F, Kaar T K, McGuinness A J. Intraneural ganglion of the peroneal nerve: A case report.  Ir Med J. 1995;  88 131
• 66 Okada K, Unoki E, Kubota H, Abe E, Taniwaki M, Morita M, Sato K. Periosteal ganglion: A report of three new cases including MRI findings and a review of the literature.  Skeletal Radiol. 1996;  25 153-157
• 67 O'Rourke P J, Byrne J J. Giant ganglion of the proximal tibiofibular joint: A case report.  Ir J Med Sci. 1995;  164 295-296
• 68 Pagnoux C, Lhotellier L, Marek J J, Ballard M, Chazerain P, Ziza J M. Synovial cysts of the proximal tibiofibular joint: Three case reports.  Joint Bone Spine. 2002;  69 331-333
• 69 Parkes A. Intraneural ganglion of the lateral popliteal nerve.  J Bone Joint Surg [Br]. 1961;  43 784-790
• 70 Päzolt H J, Martin H. Intraneurale Ganglien des N. peronaeus communis.  Zentralbl Chir. 1987;  112 105-108
• 71 Pazzaglia U E, Pedrotti L, Finardi E. Kyste synovial intranerveux du nerf sciatique poplité externe.  Acta Orthop Belg. 1989;  55 253-256
• 72 Pedrazzini M, Pogliacomi F, Cusmano F, Armaroli S, Rinaldi E, Pavone P. Bilateral ganglion cyst of the common peroneal nerve.  Eur Radiol. 2002;  12 2803-2806
• 73 Penkert G, Winkler D. Intraneurales Pseudoganglion des Nervus peronaeus communis.  Handchir Mikrochir Plast Chir. 1982;  14 14-17
• 74 Petit-Lacour M C, Pico F, Rappoport N, Gagey O, Said G. Fluctuating peroneal nerve palsy caused by an intraneural cyst.  J Neurol. 2002;  249 490-491
• 75 Poppi M, Nasi M T, Guiliani G, Acciarri N, Montagna P. Intraneural ganglion of the peroneal nerve: An unusual presentation. Case report.  Surg Neurol. 1989;  31 405-406
• 76 Ramelli G P, Nagy L, Tuncdogan E, Mathis J. Ganglion cyst of the peroneal nerve: A differential diagnosis of peroneal nerve entrapment neuropathy.  Eur Neurol. 1999;  41 56-58
• 77 Rao A S, Das G C. Ganglion cysts of the lateral popliteal nerve.  Indian J Med Sci. 1967;  21 322-324
• 78 Rozbruch S R, Chang V, Bohne W HO, Deland J T. Ganglion cysts of the lower extremity: An analysis of 54 cases and review of the literature.  Orthopedics. 1998;  21 141-148
• 79 Schepsis A A, Lynch G. Exertional compartment syndromes of the lower extremity.  Curr Opin Rheumatol. 1996;  8 143-147
• 80 Scherman B M, Bilbao J M, Hudson A R, Briggs S J. Intraneural ganglion: A case report with electron microscopic observations.  Neurosurgery. 1981;  8 487-490
• 81 Schmitz A, Wagner U A, Schmitt O. Intraneurales Ganglion des Nervus peronaeus.  Sportverl Sportschad. 1997;  11 70-72
• 82 Soren A. Pathogenesis and treatment of ganglion.  Clin Orthop. 1966;  48 173-179
• 83 Spinner R J, Atkinson J LD, Scheithauer B W, Rock M G, Birch R, Kim T A, Kliot M, Kline D G, Tiel R L. Peroneal intraneural ganglia: The importance of the articular branch. Clinical series.  J Neurosurg. 2003;  99 319-329
• 84 Spinner R J, Atkinson J LD, Tiel R L. Peroneal intraneural ganglia: The importance of the articular branch. A unifying theory.  J Neurosurg. 2003;  99 330-343
• 85 Spinner R J, Atkinson J LD, Harper C M, Wenger D E. Recurrent intraneural ganglion cyst of the tibial nerve.  J Neurosurg. 2000;  92 324-337
• 86 Srour R, Boyer P, Oesterle H, Stilhart B, Coscia S, Scheremet R. Pseudo-kyste mucoïde du sciatique poplité externe.  Neurochirurgie. 1996;  42 66-70
• 87 Stack R E, Bianco A J, MacCarty C S. Compression of the common peroneal nerve by ganglion cysts.  J Bone Joint Surg [Am]. 1965;  47 773-778
• 88 Stener B. Unusual ganglion cysts in the neighbourhood of the knee joint.  Acta Orthop Scand. 1969;  40 392-401
• 89 Sultan C. Ganglion der Nervenscheide des Nervus peronaeus.  Zentralbl Chir. 1921;  48 963-965
• 90 Tupman G S. Axonotmesis of anterior tibial branch of lateral popliteral nerve due to ganglion of the nerve-sheath.  Brit J Surg. 1957;  45 23-24
• 91 Uetani M, Hashmi R, Hayashi K, Nagatani Y, Narabayashi Y, Imamura K. Peripheral nerve intraneural ganglion cyst: MR findings in three cases.  J Comput Assist Tomogr. 1998;  22 629-632
• 92 Valls R, Melloni P, Darnell A, Muñoz J, Canalies J. Diagnostic imaging of tibial periosteal ganglion.  Eur Radiol. 1997;  7 70-72
• 93 Ward W G, Eckhardt J J. Ganglion cyst of the proximal tibiofibular joint causing anterior compartment syndrome. A case report and anatomical study.  J Bone Joint Surg [Am]. 1994;  76 1561-1564
• 94 Warren R. Ganglion of the common peroneal nerve. Case report.  Ann Surg. 1946;  124 152-155
• 95 Yamazaki H, Saitoh S, Seki H, Murakami N, Misawa T, Takaoka K. Peroneal nerve palsy caused by intraneural ganglion.  Skeletal Radiol. 1999;  28 52-56