{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:55:02Z","timestamp":1781909702361,"version":"3.54.5"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"\n BACKGROUND<\/jats:title>\n Intraneural ganglion cysts (IGCs) are mucinous lesions that originate from adjacent synovial joints. According to the articular theory, synovial fluid tracks from a joint into the parent nerve through an articular branch. In uncommon sites such as the sural nerve, this connection can be difficult to identify. This report illustrates the use of a preoperative intra-articular fluorescein injection as a tool to identify the articular branch during surgery.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 60-year-old woman presented with lateral foot pain, numbness, and a palpable mass along the left sural distribution. MRI showed a large cyst extending along the course of the sural nerve with connection to the subtalar joint. Fluorescein was injected preoperatively into this joint to detect the articular branch intraoperatively with ultraviolet illumination. The connection was transected at the joint origin, and the cyst was decompressed, preserving the parent nerve. Postoperatively, the patient had complete pain relief and sensory recovery, and MRI at 3 and 8 months confirmed resolution of the cyst.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Sural IGCs conform to the articular theory and can be managed effectively by transection of the articular branch. Preoperative intra-articular fluorescein injection is a useful tool to detect the articular branch that can be difficult to find in sural IGCs.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE251018<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case251018","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:12:56Z","timestamp":1773925976000},"source":"Crossref","is-referenced-by-count":1,"title":["Preoperative intra-articular fluorescein injection to detect the articular branch at surgery on a sural intraneural ganglion cyst at the ankle: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2900-5310","authenticated-orcid":true,"given":"Rahul","family":"Gogoi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-7763","authenticated-orcid":true,"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emile G.","family":"Coerkamp","sequence":"additional","affiliation":[{"name":"Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godard C. W.","family":"de Ruiter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"J Neurosurg","first-page":"615","article-title":"Intraneural ganglion cysts: a systematic review and reinterpretation of the world\u2019s literature","volume":"125","author":"Desy","year":"2016","unstructured":"Desy NMWang HElshiekh MAIIntraneural ganglion cysts: a systematic review and reinterpretation of the world\u2019s literature. J Neurosurg. 2016;125(3):615-630. doi:10.3171\/2015.9.JNS141368"},{"issue":"3","key":"bib2","series-title":"J Bone Joint Surg Br","first-page":"465","article-title":"Entrapment neuropathy of the sural nerve","volume":"56B","author":"Pringle","year":"1974","unstructured":"Pringle RMProtheroe KMukherjee SK.Entrapment neuropathy of the sural nerve. J Bone Joint Surg Br. 1974;56B(3):465-468. doi:10.1302\/0301-620X.56B3.465"},{"issue":"1","key":"bib3","series-title":"J Foot Surg","first-page":"14","article-title":"Mucinous cyst of the sural nerve","volume":"25","author":"Herrin","year":"1986","unstructured":"Herrin ELepow GMBruyn JM.Mucinous cyst of the sural nerve. J Foot Surg. 1986;25(1):14-18."},{"issue":"4","key":"bib4","series-title":"Int Orthop","first-page":"269","article-title":"Benign cystic lesions of peripheral nerves","volume":"12","author":"H\u00f8gh","year":"1988","unstructured":"H\u00f8gh J.Benign cystic lesions of peripheral nerves. Int Orthop. 1988;12(4):269-271. doi:10.1007\/BF00317822"},{"issue":"3","key":"bib5","series-title":"J Foot Surg","first-page":"231","article-title":"Sural neuropathy produced by intraneural ganglion","volume":"29","author":"Acciarri","year":"1990","unstructured":"Acciarri NGiuliani GPoppi MPaolo Fabrizi AFerracini R.Sural neuropathy produced by intraneural ganglion. J Foot Surg. 1990;29(3):231-232."},{"issue":"3","key":"bib6","series-title":"J Foot Ankle Surg","first-page":"199","article-title":"A posttraumatic, joint-connected sural intraneural ganglion cyst\u2014with a new mechanism of intraneural recurrence: a case report","volume":"47","author":"Blitz","year":"2008","unstructured":"Blitz NMPrestridge JAmrami KKSpinner RJ.A posttraumatic, joint-connected sural intraneural ganglion cyst\u2014with a new mechanism of intraneural recurrence: a case report. J Foot Ankle Surg. 2008;47(3):199-205. doi:10.1053\/j.jfas.2008.01.002"},{"issue":"4","key":"bib7","series-title":"Seikei Geka","first-page":"353","article-title":"Intraneural ganglion cyst in the foot: report of three cases","volume":"60","author":"Araki","year":"2009","unstructured":"Araki NOnomakawa SMatsuda TTanaka YTakakura Y.Intraneural ganglion cyst in the foot: report of three cases. Article in Japanese. Seikei Geka. 2009;60(4):353-355."},{"key":"bib8","series-title":"J Korean Soc Plast Reconstr Surg","first-page":"839","article-title":"Epineural ganglion cyst of the sural nerve at the foot: a case report","volume":"37","author":"Kim","year":"2010","unstructured":"Kim CHKim HS.Epineural ganglion cyst of the sural nerve at the foot: a case report. J Korean Soc Plast Reconstr Surg. 2010;37:839-842."},{"issue":"4","key":"bib9","series-title":"J Korean Foot Ankle Soc","first-page":"223","article-title":"Intraneural ganglion cyst in the foot and ankle","volume":"15","author":"Choi","year":"2011","unstructured":"Choi JSKim KHKwak JHPark HGLee SW.Intraneural ganglion cyst in the foot and ankle. J Korean Foot Ankle Soc. 2011;15(4):223-231."},{"issue":"1","key":"bib10","series-title":"Arch Plast Surg","first-page":"77","article-title":"Sural intraneural ganglion cysts are joint-related","volume":"39","author":"Spinner","year":"2012","unstructured":"Spinner RJAmrami KKIbrahim Elshiekh MABlitz NM.Sural intraneural ganglion cysts are joint-related. Arch Plast Surg. 2012;39(1):77-79. doi:10.5999\/aps.2012.39.1.77B"},{"key":"bib11","series-title":"J Korean Assoc Pain Med","first-page":"32","article-title":"A case of isolated sural neuropathy caused by intraneural ganglion: a case report","volume":"12","author":"Kim","year":"2013","unstructured":"Kim WKKang SHKim DKSeo KMKang AJRo HJ.A case of isolated sural neuropathy caused by intraneural ganglion: a case report. J Korean Assoc Pain Med. Article in Korean. 2013;12:32-36."},{"issue":"8","key":"bib12","series-title":"Neurology","first-page":"e95","article-title":"Teaching NeuroImages: recurrence of a sural intraneural ganglion cyst after sural nerve resection","volume":"83","author":"Ogose","year":"2014","unstructured":"Ogose AHotta TKawashima HYamagiwa HEndo NUmezu H.Teaching NeuroImages: recurrence of a sural intraneural ganglion cyst after sural nerve resection. Neurology. 2014;83(8):e95-e96. doi:10.1212\/WNL.0000000000000714"},{"key":"bib13","article-title":"Intraneural ganglion of the sural nerve: a case report and systematic review","author":"Wade","year":"2016;","unstructured":"Wade RGJia XRobinson PSmith IM.Intraneural ganglion of the sural nerve: a case report and systematic review [poster]. Presented at: American Society for Peripheral Nerve (ASPN) Annual Meeting; January 15\u201317, 2016; Scottsdale, AZ."},{"issue":"5","key":"bib14","series-title":"G Ital Radiol Med","first-page":"655","article-title":"Imaging of an unusual case of a sural intraneural ganglion cyst","volume":"5","author":"Foresti","year":"2018","unstructured":"Foresti M.Imaging of an unusual case of a sural intraneural ganglion cyst. G Ital Radiol Med. 2018;5(5):655-659. doi:10.23736\/S2283-8376.18.00113-4"},{"issue":"1","key":"bib15","series-title":"Surg Radiol Anat","first-page":"221","article-title":"The sensory innervation pattern of the ankle: a systematic review","volume":"47","author":"Hohenberger","year":"2025","unstructured":"Hohenberger GWittig UPretterklieber MHammer NPretterklieber B.The sensory innervation pattern of the ankle: a systematic review. Surg Radiol Anat. 2025;47(1):221. doi:10.1007\/s00276-025-03742-5"},{"issue":"4","key":"bib16","series-title":"Neurosurg Rev","first-page":"547","article-title":"Fluorescein-guided surgery for malignant gliomas: a review","volume":"37","author":"Acerbi","year":"2014","unstructured":"Acerbi FCavallo CBroggi MFluorescein-guided surgery for malignant gliomas: a review. Neurosurg Rev. 2014;37(4):547-557. doi:10.1007\/s10143-014-0546-6"},{"issue":"1","key":"bib17","series-title":"Anesthesiology","first-page":"146","article-title":"Permeability of injured and intact peripheral nerves and dorsal root ganglia","volume":"105","author":"Abram","year":"2006","unstructured":"Abram SEYi JFuchs AHogan QH.Permeability of injured and intact peripheral nerves and dorsal root ganglia. Anesthesiology. 2006;105(1):146-153. doi:10.1097\/00000542-200607000-00024"},{"issue":"3","key":"bib18","series-title":"Acta Neurochir (Wien)","first-page":"651","article-title":"Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts","volume":"160","author":"Stone","year":"2018","unstructured":"Stone JJGraffeo CSde Ruiter GCWRock MGSpinner RJ.Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts. Acta Neurochir (Wien). 2018;160(3):651-654. doi:10.1007\/s00701-018-3477-0"},{"key":"bib19","series-title":"Clin Anat","article-title":"Natural openings in the paraneurium and epineurium of the human sciatic nerve and their relationship to the entry and exit of blood vessels. A microanatomical study","author":"de Ruiter","year":"2025","unstructured":"de Ruiter GCWSpinner RJSala-Blanch XReina MA.Natural openings in the paraneurium and epineurium of the human sciatic nerve and their relationship to the entry and exit of blood vessels. A microanatomical study. Clin Anat. 2025. doi:10.1002\/ca.70021"},{"issue":"2","key":"bib21","series-title":"J Neurosurg","first-page":"330","article-title":"Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory","volume":"99","author":"Spinner","year":"2003","unstructured":"Spinner RJAtkinson JLDTiel RL.Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg. 2003;99(2):330-343. doi:10.3171\/jns.2003.99.2.0330"},{"issue":"20","key":"bib22","series-title":"J Neurosurg Case Lessons","first-page":"CASE24564","article-title":"Median intraneural ganglion cyst at the elbow: the first known example of a joint connection and a reflection on the past. Illustrative case","volume":"8","author":"Maldonado","year":"2024","unstructured":"Maldonado AAAmrami KKHirche CSpinner RJ.Median intraneural ganglion cyst at the elbow: the first known example of a joint connection and a reflection on the past. Illustrative case. J Neurosurg Case Lessons. 2024;8(20):CASE24564. doi:10.3171\/CASE24564"},{"issue":"3","key":"bib1","series-title":"J Neurosurg","first-page":"615","article-title":"Intraneural ganglion cysts: a systematic review and reinterpretation of the world\u2019s literature","volume":"125","author":"Desy","year":"2016","unstructured":"Desy NMWang HElshiekh MAIIntraneural ganglion cysts: a systematic review and reinterpretation of the world\u2019s literature. J Neurosurg. 2016;125(3):615-630. doi:10.3171\/2015.9.JNS141368"},{"issue":"3","key":"bib2","series-title":"J Bone Joint Surg Br","first-page":"465","article-title":"Entrapment neuropathy of the sural nerve","volume":"56B","author":"Pringle","year":"1974","unstructured":"Pringle RMProtheroe KMukherjee SK.Entrapment neuropathy of the sural nerve. J Bone Joint Surg Br. 1974;56B(3):465-468. doi:10.1302\/0301-620X.56B3.465"},{"issue":"1","key":"bib3","series-title":"J Foot Surg","first-page":"14","article-title":"Mucinous cyst of the sural nerve","volume":"25","author":"Herrin","year":"1986","unstructured":"Herrin ELepow GMBruyn JM.Mucinous cyst of the sural nerve. J Foot Surg. 1986;25(1):14-18."},{"issue":"4","key":"bib4","series-title":"Int Orthop","first-page":"269","article-title":"Benign cystic lesions of peripheral nerves","volume":"12","author":"H\u00f8gh","year":"1988","unstructured":"H\u00f8gh J.Benign cystic lesions of peripheral nerves. Int Orthop. 1988;12(4):269-271. doi:10.1007\/BF00317822"},{"issue":"3","key":"bib5","series-title":"J Foot Surg","first-page":"231","article-title":"Sural neuropathy produced by intraneural ganglion","volume":"29","author":"Acciarri","year":"1990","unstructured":"Acciarri NGiuliani GPoppi MPaolo Fabrizi AFerracini R.Sural neuropathy produced by intraneural ganglion. J Foot Surg. 1990;29(3):231-232."},{"issue":"3","key":"bib6","series-title":"J Foot Ankle Surg","first-page":"199","article-title":"A posttraumatic, joint-connected sural intraneural ganglion cyst\u2014with a new mechanism of intraneural recurrence: a case report","volume":"47","author":"Blitz","year":"2008","unstructured":"Blitz NMPrestridge JAmrami KKSpinner RJ.A posttraumatic, joint-connected sural intraneural ganglion cyst\u2014with a new mechanism of intraneural recurrence: a case report. J Foot Ankle Surg. 2008;47(3):199-205. doi:10.1053\/j.jfas.2008.01.002"},{"issue":"4","key":"bib7","series-title":"Seikei Geka","first-page":"353","article-title":"Intraneural ganglion cyst in the foot: report of three cases","volume":"60","author":"Araki","year":"2009","unstructured":"Araki NOnomakawa SMatsuda TTanaka YTakakura Y.Intraneural ganglion cyst in the foot: report of three cases. Article in Japanese. Seikei Geka. 2009;60(4):353-355."},{"key":"bib8","series-title":"J Korean Soc Plast Reconstr Surg","first-page":"839","article-title":"Epineural ganglion cyst of the sural nerve at the foot: a case report","volume":"37","author":"Kim","year":"2010","unstructured":"Kim CHKim HS.Epineural ganglion cyst of the sural nerve at the foot: a case report. J Korean Soc Plast Reconstr Surg. 2010;37:839-842."},{"issue":"4","key":"bib9","series-title":"J Korean Foot Ankle Soc","first-page":"223","article-title":"Intraneural ganglion cyst in the foot and ankle","volume":"15","author":"Choi","year":"2011","unstructured":"Choi JSKim KHKwak JHPark HGLee SW.Intraneural ganglion cyst in the foot and ankle. J Korean Foot Ankle Soc. 2011;15(4):223-231."},{"issue":"1","key":"bib10","series-title":"Arch Plast Surg","first-page":"77","article-title":"Sural intraneural ganglion cysts are joint-related","volume":"39","author":"Spinner","year":"2012","unstructured":"Spinner RJAmrami KKIbrahim Elshiekh MABlitz NM.Sural intraneural ganglion cysts are joint-related. Arch Plast Surg. 2012;39(1):77-79. doi:10.5999\/aps.2012.39.1.77B"},{"key":"bib11","series-title":"J Korean Assoc Pain Med","first-page":"32","article-title":"A case of isolated sural neuropathy caused by intraneural ganglion: a case report","volume":"12","author":"Kim","year":"2013","unstructured":"Kim WKKang SHKim DKSeo KMKang AJRo HJ.A case of isolated sural neuropathy caused by intraneural ganglion: a case report. J Korean Assoc Pain Med. Article in Korean. 2013;12:32-36."},{"issue":"8","key":"bib12","series-title":"Neurology","first-page":"e95","article-title":"Teaching NeuroImages: recurrence of a sural intraneural ganglion cyst after sural nerve resection","volume":"83","author":"Ogose","year":"2014","unstructured":"Ogose AHotta TKawashima HYamagiwa HEndo NUmezu H.Teaching NeuroImages: recurrence of a sural intraneural ganglion cyst after sural nerve resection. Neurology. 2014;83(8):e95-e96. doi:10.1212\/WNL.0000000000000714"},{"key":"bib13","article-title":"Intraneural ganglion of the sural nerve: a case report and systematic review","author":"Wade","year":"2016;","unstructured":"Wade RGJia XRobinson PSmith IM.Intraneural ganglion of the sural nerve: a case report and systematic review [poster]. Presented at: American Society for Peripheral Nerve (ASPN) Annual Meeting; January 15\u201317, 2016; Scottsdale, AZ."},{"issue":"5","key":"bib14","series-title":"G Ital Radiol Med","first-page":"655","article-title":"Imaging of an unusual case of a sural intraneural ganglion cyst","volume":"5","author":"Foresti","year":"2018","unstructured":"Foresti M.Imaging of an unusual case of a sural intraneural ganglion cyst. G Ital Radiol Med. 2018;5(5):655-659. doi:10.23736\/S2283-8376.18.00113-4"},{"issue":"1","key":"bib15","series-title":"Surg Radiol Anat","first-page":"221","article-title":"The sensory innervation pattern of the ankle: a systematic review","volume":"47","author":"Hohenberger","year":"2025","unstructured":"Hohenberger GWittig UPretterklieber MHammer NPretterklieber B.The sensory innervation pattern of the ankle: a systematic review. Surg Radiol Anat. 2025;47(1):221. doi:10.1007\/s00276-025-03742-5"},{"issue":"4","key":"bib16","series-title":"Neurosurg Rev","first-page":"547","article-title":"Fluorescein-guided surgery for malignant gliomas: a review","volume":"37","author":"Acerbi","year":"2014","unstructured":"Acerbi FCavallo CBroggi MFluorescein-guided surgery for malignant gliomas: a review. Neurosurg Rev. 2014;37(4):547-557. doi:10.1007\/s10143-014-0546-6"},{"issue":"1","key":"bib17","series-title":"Anesthesiology","first-page":"146","article-title":"Permeability of injured and intact peripheral nerves and dorsal root ganglia","volume":"105","author":"Abram","year":"2006","unstructured":"Abram SEYi JFuchs AHogan QH.Permeability of injured and intact peripheral nerves and dorsal root ganglia. Anesthesiology. 2006;105(1):146-153. doi:10.1097\/00000542-200607000-00024"},{"issue":"3","key":"bib18","series-title":"Acta Neurochir (Wien)","first-page":"651","article-title":"Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts","volume":"160","author":"Stone","year":"2018","unstructured":"Stone JJGraffeo CSde Ruiter GCWRock MGSpinner RJ.Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts. Acta Neurochir (Wien). 2018;160(3):651-654. doi:10.1007\/s00701-018-3477-0"},{"key":"bib19","series-title":"Clin Anat","article-title":"Natural openings in the paraneurium and epineurium of the human sciatic nerve and their relationship to the entry and exit of blood vessels. A microanatomical study","author":"de Ruiter","year":"2025","unstructured":"de Ruiter GCWSpinner RJSala-Blanch XReina MA.Natural openings in the paraneurium and epineurium of the human sciatic nerve and their relationship to the entry and exit of blood vessels. A microanatomical study. Clin Anat. 2025. doi:10.1002\/ca.70021"},{"issue":"2","key":"bib21","series-title":"J Neurosurg","first-page":"330","article-title":"Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory","volume":"99","author":"Spinner","year":"2003","unstructured":"Spinner RJAtkinson JLDTiel RL.Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg. 2003;99(2):330-343. doi:10.3171\/jns.2003.99.2.0330"},{"issue":"20","key":"bib22","series-title":"J Neurosurg Case Lessons","first-page":"CASE24564","article-title":"Median intraneural ganglion cyst at the elbow: the first known example of a joint connection and a reflection on the past. Illustrative case","volume":"8","author":"Maldonado","year":"2024","unstructured":"Maldonado AAAmrami KKHirche CSpinner RJ.Median intraneural ganglion cyst at the elbow: the first known example of a joint connection and a reflection on the past. Illustrative case. J Neurosurg Case Lessons. 2024;8(20):CASE24564. doi:10.3171\/CASE24564"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/10\/article-CASE251018.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/10\/article-CASE251018.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/10\/article-CASE251018.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:26:07Z","timestamp":1776093967000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/10\/article-CASE251018.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":42,"journal-issue":{"issue":"10"},"URL":"https:\/\/doi.org\/10.3171\/case251018","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}