-

Abstract

Extraneural ganglion cysts of the peroneal nerve have rarely been reported in the literature. This paper reports a large extraneural ganglion cyst compressing the peroneal nerve and causing pain in the leg, and foot drop. Electromyographic study revealed a deep peroneal nerve lesion, but the superficial branch was spared. Magnetic resonance imaging showed a cystic tumor located below the superior tibiofibular joint. A complete surgical resection was undertaken. During surgery multimodal intraoperative neurophysiological monitoring was performed. An extraneural ganglion cyst should be considered in the differential diagnosis of painful foot drop. Electrophysiological and radiological studies should be carried to rule out other causes of foot drop

Keywords

• Foot drop, Extraneural ganglion, Cyst, Peroneal nerve

Düşük ayağa yol açan, peroneal sinir komşuluğunda dev ekstranöral ganglion kisti olgusu

Abstract

Peroneal sinirin ekstranöral ganglion kistlerine literaturde az rastlanmaktadır. Bu makalede bacakta ağrı ve düşük ayağa yol açan, peroneal sinire dışarıdan bası yapan, geniş çaplı bir ekstranöral ganglion kisti olgusu sunuldu. Elektromiyografi peroneal sinirin derin dal tutulumuna işaret etti. Manyetik rezonans görüntüleme ise tibiofibular eklem distalinde kistik bir lezyonu ortaya koydu. Ameliyat esnasında multimodal nörofizyolojik monitörizasyon yapıldı.Hastada kist tümüyle rezeke edildi. Ekstranöral peroneal ganglion kisti, ağrılı düşük ayak nedenleri arasında akla getirilmelidir.

Keywords

• Düşük ayak, Ekstranöral ganglion, Kist, Peroneal sinir

References

1. 1. Strickland JW, Steichen JB. Nerve tumors of the hand and forearm. J Hand Surg 1977; 2A: 285-91.
2. 2. Sultan C. Ganglion der nervenscheide des nervus peroneus. Zentralblatt für Chirurgie 1921:48:963-5.
3. 3. Spinner RJ, Atkinson JLD, Tiel RL. Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 2003 ;99: 330-43.
4. 4. Sidey JD. Weak ankles. A study of common peroneal entrapment neuropathy. Br Med J 1969: 13;623-6.
5. 5. Gurdjian ES, Larsen RD Lindner DW. Intraneural cyst of the peroneal and ulnar nerves. Report of two cases. J Neurosurg 1965; 23:76-8.
6. 6. Ducic I, Dellon AL, Graw KS. The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid third of the lateral leg. Ann Plast Surg 2006; 56:635-8.
7. 7. Ryan W, Mahony N, Delaney M, et al. Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat 2003;16:501-5.
8. 8. Ghossain M, Mohasseb G, Dagher F, et al. Compression of the common

9. peroneal nerve by a sinovial cyst. Neurochirurgie 1987; 33:412-3. 9. Rawal A, Ratnam KR, Yin Q, et al. Compression neuropathy of common peroneal nerve caused by an extraneural ganglion: A report of two cases: Microsurgery 2004; 24:63-6.
10. 10. Brooks DM. Nerve compression by simple ganglia: a review of thirteen collected cases. J Bone Joint Surg (Br) 1952; 34:391.
11. 11. Coleman SH, Beredjeklian PK, Weiland AJ. Intraneuronal ganglion cyst of the peroneal nerve accompanied by complete foot drop. A case report. Am J Sports Med 2001; 29:238-41.
12. 12. Johnston JA, Lyne DE. Intraneural ganglion cyst of the peroneal nerve in a four-year-old girl. J Pediatr Orthop 2007;27:944-6. doi: 10.1097/ BPO.0b013e3181558c05.
13. 13. Kahraman O, Akman S, Erturer E, et al. A case of an intraneural ganglion cyst in the peroneal nerve resulting in foot drop. Acta Orthop Traumatol Turc 2000; 34:426-9.
14. 14. Spinner RJ, Ibrahim Elshiekh MA, et al. Posttraumatic torsional injury as an indirect cause of fibular intraneural ganglion cysts: Clin Anat Oct 24. doi: 10.1002/ca.21290. 2011 [Epub ahead of print]
15. 15. Tehli O, Celikmez RC, Birgili B, et al. Pure peroneal intraneural ganglion cyst ascending along the sciatic nerve. Turk Neurosurg 2011;21:254-8. doi: 10.5137/1019-5149.JTN.2660-09.1, 2011
16. 16. Leon J, Marano G. MRI of peroneal nerve entrapment due to ganglion cyst. Magn Res Imag 1987; 5:307-9.
17. 17. Kim JH, Ihn YK, Kim JS, et al. Nontraumatic peroneal nerve palsy: MRI findings. Clin Radiol 2007; 62:58-64.
18. 18. Ramelli GP, Nagy L, Tuncdogan E, et al. Ganglion cyst of the peroneal nerve. A differential diagnosis of peroneal nerve entrapment neuropathy. Eur Neurol 1999; 41:56-8.
19. 19. Rein S, Weindel S, Schaller HE, et al. Peroneal nerve palsy caused by a recurrent proximal tibiofibular joint ganglion – a case report and review of the literature. Handchir Mikrochir Plast Chir; 2005; 37:267- 75.
20. 20. Yamazaki H, Saitoh S, Seki H, et al. Peroneal nerve palsy caused by intraneural ganglion. Skeletal Radiol 1999; 28:52-6.