Intraneural ganglion cyst of the peroneal nerve at the lateral knee: A case report and literature review
Keywords:Peroneal neuropathy, Foot drop, Ganglion cyst
Introduction: Intraneural ganglion cysts can arise from the peroneal nerve at the lateral knee secondary to synovial fluid tracking along the articular branch and transforming within the nerve into a mucinous cyst, resulting in nerve compression.
Case Report: A 17-year-old right-handed male presented with a four-month history of right foot drop. He is physically active and attributed the foot drop to a sprained ankle. EMG/NCS showed a right common peroneal neuropathy distal to the innervation of the biceps femoris short head with active denervation. MRI showed an intraneural ganglion cyst in the common peroneal nerve starting at the level of biceps femoris. On exam, he had right foot drop and sensory deficits referable to the peroneal distribution, along with a right steppage gait. He had successful decompression of the ganglion cyst, excision of the articular branch and resection of the proximal tibiofibular joint, with clinical improvement.
Conclusion: Early recognition and surgical treatment leads to better outcomes for patients when an intraneural ganglion cyst results in neurologic deficits. Physical activities and trauma, which increase stress on the knee joints, may predispose ganglion cyst formation within peroneal nerves. Fibers of the deep peroneal nerve may be preferentially affected when compared to the superficial peroneal nerve. Disconnection of the articular branch and proximal tibiofibular joint resection may decrease risk of recurrence.
Katirji MB, Wilbourn AJ. Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions. Neurology. Nov 1988;38(11):1723-8. doi:10.1212/wnl.38.11.1723
Visser LH. High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology. Oct 24 2006;67(8):1473-5. doi:10.1212/01.wnl.0000240070.98910.bc
Spinner RJ, Atkinson JL, Tiel RL. Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg. Aug 2003;99(2):330-43. doi:10.3171/jns.2003.99.2.0330
Preston DC, Shapiro BE. Electromyography and neuromuscular disorders : clinical-electrophysiologic correlations. 3rd ed. Elsevier Saunders; 2013:xvii, 643 p.
Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology. Apr 30 2013;80(18):1634-40. doi:10.1212/WNL.0b013e3182904f3f
Lenartowicz KA, Wolf AS, Desy NM, Strakowski JA, Amrami KK, Spinner RJ. Preoperative Imaging of Intraneural Ganglion Cysts: A Critical Systematic Analysis of the World Literature. World Neurosurg. Oct 2022;166:e968-e979. doi:10.1016/j.wneu.2022.08.005
Huntington LS, Talia A, Devitt BM, Batty L. Management and outcomes of proximal tibiofibular joint ganglion cysts: A systematic review. Knee. Aug 2022;37:60-70. doi:10.1016/j.knee.2022.05.009
Lipinski LJ, Rock MG, Spinner RJ. Peroneal intraneural ganglion cysts at the fibular neck: the layered "U" surgical approach to the articular branch and superior tibiofibular joint. Acta Neurochir (Wien). May 2015;157(5):837-40. doi:10.1007/s00701-014-2323-2
How to Cite
Copyright (c) 2023 Jonathan Morena DO, Brian Yang MD, Steve K Lee MD, Dustin J. Paul MD, Dora Leung MD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.