Abstract:
OBJECT:Intraneural ganglia are nonneoplastic mucinous cysts contained within the epineurium of peripheral nerves. Their pathogenesis has been controversial. Historically, the majority of authors have favored de novo formation (degenerative theory). Because of their rarity, intraneural ganglia affecting the upper limb have been misunderstood. This study was designed to critically analyze the literature and to test the hypothesis that intraneural ganglia of the upper limb act analogously to those in the lower limb, being derived from an articular source (synovial theory). METHODS:Two patients with digital intraneural cysts were included in the study. An extensive literature review of intraneural ganglia of the upper limb was undertaken to provide the historical basis for the study. RESULTS:In both cases, the digital intraneural ganglia were demonstrated to have joint connections; the one patient in whom an articular branch was not appreciated initially had evidence on postoperative MR images of persistence of intraneural cyst after simple decompression was performed. Eighty-six cases of intraneural lesions were identified in varied locations of the upper limb: the most common sites were the ulnar nerve at the elbow and wrist, occurring 38 and 22 times, respectively. Joint connections were present in only 20% of the cases published by other groups. CONCLUSIONS:The authors believe that the fundamental principles of the unifying articular (synovial) theory (that is, articular branch connections, cyst fluid following a path of least resistance, and the role of pressure fluxes) previously described to explain intraneural ganglia in the lower limb apply to those cases in the upper limb. In their opinion, the joint connection is often not identified because of the cysts' rarity, radiologists' and surgeons' inexperience, and the difficulty visualizing and demonstrating it because of the small size of the cysts. Furthermore, they believe that recurrence (subclinical or clinical) is not only underreported but also predictable after simple decompression that fails to address the articular branch. In contrast, intraneural recurrence can be eliminated with disconnection of the articular branch.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Wang H,Terrill RQ,Tanaka S,Amrami KK,Spinner RJdoi
10.3171/FOC.2009.26.2.E10subject
Has Abstractpub_date
2009-02-01 00:00:00pages
E10issue
2issn
1092-0684journal_volume
26pub_type
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.8.FOCUS17421
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
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doi:10.3171/2011.8.FOCUS11132
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1999.7.2.3
更新日期:1999-08-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.12.4.2
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journal_title:Neurosurgical focus
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abstract::OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the dif...
journal_title:Neurosurgical focus
pub_type: 杂志文章
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更新日期:2016-11-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.9.FOCUS20559
更新日期:2020-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
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journal_title:Neurosurgical focus
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doi:10.3171/2020.1.FOCUS19920
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pub_type: 历史文章,杂志文章,评审
doi:10.3171/foc.2007.23.1.8
更新日期:2007-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2004.17.1.1
更新日期:2004-07-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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更新日期:2005-03-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:10.3171/2010.9.FOCUS10191
更新日期:2010-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2004.16.2.8
更新日期:2004-02-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1997.3.2.5
更新日期:1997-08-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.1.FOCUS09303
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.12.FOCUS09281
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pub_type: 杂志文章
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更新日期:2009-05-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2011.2.FOCUS10301
更新日期:2011-04-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.9.FOCUS20537
更新日期:2020-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.1.FOCUS14743
更新日期:2015-03-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2012.12.FOCUS12338
更新日期:2013-02-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.9.FOCUS18381
更新日期:2018-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1998.4.1.11
更新日期:1998-06-15 00:00:00
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pub_type: 杂志文章
doi:10.3171/foc.2001.10.6.3
更新日期:2001-06-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
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更新日期:2004-01-15 00:00:00
abstract::Epidermoid cysts or tumors comprise 1% of intracranial tumors with a predilection for the cerebellopontine angle or parasellar cisterns. These tumors are derived from an ectopic ectodermal implant seeded between fusing ectodermal surfaces. This results in a benign proliferation of stratified squamous epithelium along ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
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