caa a22 4500 606216324 CHVBK 20210128101102.0 cr unu---uuuuu 210128e20150501xx s 000 0 eng 10.1007/s00701-014-2323-2 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2323-2 Peroneal intraneural ganglion cysts at the fibular neck: the layered "U” surgical approach to the articular branch and superior tibiofibular joint [Elektronische Daten] [Lindsay Lipinski, Michael Rock, Robert Spinner] Background: Intraneural ganglia most commonly occur within the peroneal nerve near the fibular neck. Disconnection of the articular branch is required in their treatment. Surgical intervention can be challenging because of unfamiliarity with the region or scarring from previous surgery. Method: We present the layered "U” technique for peroneal intraneural ganglia with clinical examples. Dissection is carried down in parallel to the U-shaped course of the articular branch to provide optimal visualization and avoid injury to major branches of the nerve. Conclusion: This pathoanatomic approach provides direct and safe exposure of the articular branch of the common peroneal nerve. Key points: • The CPN is the most frequently affected site for IG. • PIG are becomingly increasingly recognized as causes of foot drop [9]. • PIG can represent an operative challenge, particularly in the setting of previous surgery. • Understanding the consistent U-shape of the AB and its cystic involvement in PIG allows a more efficient dissection. • A U-shaped layered approach exposes the AB. • Dissection superiorly and medially along the AB minimizes risk to the DPN and SPN. • Disconnection of the AB near the STFJ minimizes intraneural cyst recurrence and is the critical part of the procedure. • Cyst decompression may expedite symptom relief. • We have added STFJ resection (disarticulation) to our strategy to further decrease risks for intraneural and extraneural recurrence, as it removes the synovium, the source of STFJ-related ganglia. • This surgical strategy maximizes neurologic improvement and minimizes cyst recurrence. Springer-Verlag Wien, 2015 Intraneural ganglion nationallicence Cyst nationallicence Superior tibiofibular joint nationallicence Articular theory nationallicence AB : articular branch nationallicence AT : articular trunk nationallicence CPN : common peroneal nerve nationallicence DPN : deep peroneal nerve nationallicence IG : intraneural ganglia nationallicence MRI : magnetic resonance imaging nationallicence PIG : peroneal intraneural ganglia nationallicence PL : peroneus longus nationallicence SPN : superficial peroneal nerve nationallicence STFJ : superior tibiofibular joint nationallicence TA : tibialis anterior nationallicence Lipinski Lindsay Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA aut Rock Michael Departments of Orthopedics, Mayo Clinic, Rochester, MN, USA aut Spinner Robert Departments of Orthopedics, Mayo Clinic, Rochester, MN, USA aut Acta Neurochirurgica Springer Vienna 157/5(2015-05-01), 837-840 0001-6268 157:5<837 2015 157 701 https://doi.org/10.1007/s00701-014-2323-2 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2323-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lipinski Lindsay Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Rock Michael Departments of Orthopedics, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Spinner Robert Departments of Orthopedics, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/5(2015-05-01), 837-840 0001-6268 157:5<837 2015 157 701