{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:55:03Z","timestamp":1781909703116,"version":"3.54.5"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The formation and propagation of intraneural ganglion cysts (INGCs) is being elucidated by the unified articular theory. Its principles include a connection for joint fluid to egress from a synovial joint via an articular branch to a parent nerve and cyst following the path of least resistance, dependent on pressures and pressure fluxes. The occurrence of so-called extreme peroneal or tibial INGCs in the popliteal fossa extending to the sciatic nerve has been reported. One rarely described variant with a circumferential cyst within the subparaneurial compartment outside the epineurium of nerve(s) has been previously illustrated, but its mechanism and morphology have not been clarified. In this study, the authors aimed to investigate this type of cyst to challenge the principles of the unified articular theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Four novel cases of patients with peroneal INGCs and \"extreme subparaneurial cyst(s)\" of the sciatic nerve and its distal branches were investigated: 3 arose from the superior tibiofibular joint (STFJ) and 1 from the knee joint. Three other cases of recognized extreme subparaneurial cyst (2 peroneal and 1 tibial from the STFJ) and 1 case of a peroneal subparaneurial cyst in the literature were reinterpreted. Data on clinical presentation, MR images, and surgical results were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In all 8 cases, subparaneurial extension was observed to different degrees along the sciatic, tibial, common peroneal, sural, and deep and superficial peroneal nerves, as was subparaneurial-to-subparaneurial communication at the sciatic nerve bifurcation (i.e., crossover). Sequential MRI performed in 7 patients showed variable dynamic changes, including extreme ascent and descent. Extraneural rupture of the subparaneurial cyst, with spread into the surrounding tissue, was present at the sciatic nerve bifurcation in 6 cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors provide pathoanatomical and pathophysiological evidence supporting that extreme subparaneurial cysts follow the principles of the articular theory. They propose a distribution pattern that explains the occurrence and evolution of extreme subparaneurial cysts along the sciatic nerve and its distal branches in patients with peroneal or tibial INGCs and subepineurial cysts. Crossover in the subparaneurial compartment allows potentially extensive circumferential distribution within connected nerves. Also, dynamic factors can lead to dramatic changes in cyst size and appearance from reabsorption or extraneural rupture. In Part 2 of this study, the authors provide evidence showing that a fenestration in the epineurium allows cysts to pass from the subepineurial-to-subparaneurial, subparaneurial-to-subparaneurial, and subparaneurial-to-subepimyseal compartments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.jns242815","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T21:35:23Z","timestamp":1751664923000},"page":"1642-1652","source":"Crossref","is-referenced-by-count":3,"title":["Extreme subparaneurial ganglion cysts. Part 1: Principles and implications"],"prefix":"10.3171","volume":"143","author":[{"given":"Godard C. W.","family":"de Ruiter","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands;"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-chul","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Seoul St. Mary\u2019s Hospital, The Catholic University of Korea, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten M.","family":"Hayford","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Matthew","family":"Howe","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, CEU San Pablo University School of Medicine, Madrid, Spain; and"},{"name":"Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Neurosurg","first-page":"330","article-title":"Peroneal intraneural ganglia: the importance of the articular branch. 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Expanding on the term \"balloon\" sign. Acta Neurochir (Wien). 2016;158(10):1891\u20131893."},{"issue":"2","key":"b4","series-title":"Clin Anat","first-page":"111","article-title":"Cross-over: a generalizable phenomenon necessary for secondary intraneural ganglion cyst formation","volume":"21","author":"Spinner RJ","year":"2008","unstructured":"Spinner RJ, Amrami KK, Wang H, Kliot M, Carmichael SW. Cross-over: a generalizable phenomenon necessary for secondary intraneural ganglion cyst formation. Clin Anat. 2008;21(2):111\u2013118."},{"issue":"4","key":"b5","series-title":"Clin Anat","first-page":"530","article-title":"Subparaneurial ganglion cysts of the fibular and tibial nerves: a new variant of intraneural ganglion cysts","volume":"29","author":"Prasad NK","year":"2016","unstructured":"Prasad NK, Desy NM, Howe BM, Amrami KK, Spinner RJ. Subparaneurial ganglion cysts of the fibular and tibial nerves: a new variant of intraneural ganglion cysts. 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