Operative neurosurgery (Hagerstown, Md.) · 2026
Tibial and Plantar Intraneural Ganglion Cysts in the Ankle Region: Analysis Supports Articular Origin to Subtalar and Tibiotalar Joints and Differing Patterns of Propagation.
СтатьяНазвание и аннотация: Перевод в очереди
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Texakalidis Pavlos, Amrami Kimberly K, Giurini John M, de Ruiter Godard C W, Spinner Robert J
Аннотация
BACKGROUND AND OBJECTIVES: Intraneural ganglion cysts (IGCs) can arise in different nerves but are uncommon in the tibial nerve (TN) and its branches near the ankle. According to the unified articular theory, a joint connection is always present in IGCs. This study aimed to identify joint connections of tibial-region IGCs and characterize their clinical, radiological, and propagation patterns.
METHODS: A prospectively collected international database of >1100 IGCs was reviewed to identify tibial and medial plantar nerve (MPN) and lateral plantar nerve (LPN) IGCs around the ankle.
RESULTS: Sixty-two ankle region IGCs were identified: 29 involving the TN (46.8%), 25 the MPN (40.3%), and 4 the LPN (6.4%); in 4 cases, the parent nerve was indeterminate. Thirty-one (50%) cases demonstrated joint connections. Of these, all TN at/distal to the tarsal tunnel (n = 4/4, 100%), MPN (n = 16/16, 100%) and LPN IGCs (n = 2/2, 100%) had a connection to the subtalar (ST) joint. A tibial IGC just proximal to the tarsal tunnel was connected to the tibiotalar (TT) joint in 75% of cases (n = 3/4) and the ST joint in 25% of cases (n = 1/4). Surgical ligation/disconnection of the articular branch was associated with markedly lower recurrence (0/13, 0%) compared with incision or resection of cyst without ligation (8/29, 27.6%; P = .04).
CONCLUSION: Our findings support the unified articular theory. All IGCs in the ankle primarily ascend. Two distinct propagation patterns emerged: (1) those that ascend and enter the parent nerve proximal to the tarsal tunnel continue to ascend in the leg, without affecting the plantar nerves, and (2) those that ascend and enter the parent nerve at/distal to the tarsal tunnel have the potential to undergo crossover at the TN bifurcation and subsequently descend down the plantar nerves seen only in ST-origin cysts. Recognizing these pathways enhances diagnostic accuracy, directs identification of the joint of origin, and guides articular branch disconnection to reduce recurrence.
METHODS: A prospectively collected international database of >1100 IGCs was reviewed to identify tibial and medial plantar nerve (MPN) and lateral plantar nerve (LPN) IGCs around the ankle.
RESULTS: Sixty-two ankle region IGCs were identified: 29 involving the TN (46.8%), 25 the MPN (40.3%), and 4 the LPN (6.4%); in 4 cases, the parent nerve was indeterminate. Thirty-one (50%) cases demonstrated joint connections. Of these, all TN at/distal to the tarsal tunnel (n = 4/4, 100%), MPN (n = 16/16, 100%) and LPN IGCs (n = 2/2, 100%) had a connection to the subtalar (ST) joint. A tibial IGC just proximal to the tarsal tunnel was connected to the tibiotalar (TT) joint in 75% of cases (n = 3/4) and the ST joint in 25% of cases (n = 1/4). Surgical ligation/disconnection of the articular branch was associated with markedly lower recurrence (0/13, 0%) compared with incision or resection of cyst without ligation (8/29, 27.6%; P = .04).
CONCLUSION: Our findings support the unified articular theory. All IGCs in the ankle primarily ascend. Two distinct propagation patterns emerged: (1) those that ascend and enter the parent nerve proximal to the tarsal tunnel continue to ascend in the leg, without affecting the plantar nerves, and (2) those that ascend and enter the parent nerve at/distal to the tarsal tunnel have the potential to undergo crossover at the TN bifurcation and subsequently descend down the plantar nerves seen only in ST-origin cysts. Recognizing these pathways enhances diagnostic accuracy, directs identification of the joint of origin, and guides articular branch disconnection to reduce recurrence.