ONS Advance Access: Technique for Primary and Redo Surgery for Peroneal Intraneural Ganglion Cysts

Intraneural ganglion cysts are joint connected and arise as synovial fluid escapes the joint via a capsular defect and tracks along an articular branch of the involved nerve. The most common location of these cysts is the peroneal nerve. The joint of origin for peroneal intraneural ganglion cysts is the superior tibiofibular joint (STFJ). Patients often present with fluctuating weakness of the foot dorsiflexors and occasionally with a palpable lump around the fibular neck. With optimal technique, ultrasound and magnetic resonance imaging can both identify the presence of these cysts, though at times the findings are subtle. We present our technique to address this pathologic entity with neurolysis of the common peroneal nerve through the fibular tunnel, decompression of the cyst, disconnection of the articular branch, and resection of the joint surfaces of the STFJ. This technique addresses the source of the pathology (the STFJ) and the nerve conduit (the articular branch) in order to prevent recurrence. When the pathophysiology of this entity is not understood and the articular branch is not resected, intraneural recurrence can occur. We present a redo operation for intraneural recurrence in order to highlight the technical nuances and to emphasize the importance of addressing the source of the pathology. Informed consent was obtained from both patients included in the video.

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