{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:50Z","timestamp":1776096470222,"version":"3.50.1"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"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":[[2026,1,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Ulnar neuropathy at Guyon\u2019s canal is rare, but when it occurs, it is frequently due to underlying masses, including extraneural and intraneural ganglion cysts, as well as adventitial cysts. The pathogenesis of these cysts, especially at a rare site, remains controversial. The articular theory, which is gaining popularity, posits that a joint connection via a nerve (or vascular) branch to a neighboring joint represents the pathway for their formation and propagation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A recently published case of a patient with an ulnar intraneural ganglion at the wrist with a series of postoperative cystic recurrences was reevaluated, as it challenged the articular theory. No discrete articular branch had been identified on imaging or at surgery. Serial MR images were reinterpreted, which revealed that the original intraneural cyst was treated; new sequential cysts\u2014an adventitial cyst and then a soft tissue ganglion\u2014developed, all arising from the same wrist joint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case strengthens the principles of the articular theory for intraneural ganglion, adventitial, and soft tissue ganglion cysts. A small wrist connection from the ulnar intraneural ganglion was unrecognized and untreated. Scarring disrupted the original nerve pathway and pressure dynamics. New cysts developed through neighboring joint capsular rents along different pathways into other \u201ccompartments\u201d (vessel or soft tissues).<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25618\">https:\/\/thejns.org\/doi\/10.3171\/CASE25618<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25618","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:00Z","timestamp":1769083200000},"source":"Crossref","is-referenced-by-count":0,"title":["Metachronous ganglion cysts: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-7763","authenticated-orcid":true,"given":"Robert J.","family":"Spinner","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. Matthew","family":"Howe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8782-0647","authenticated-orcid":true,"given":"Daniel","family":"Reiser","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery and Orthopedics, Faculty of Medicine and Heath, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","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."},{"issue":"1","key":"bib2","series-title":"Case Rep Orthop Res","first-page":"39","article-title":"Intraneural ulnar nerve ganglion: a surgical case report of a 10-cm-long recurring ganglion cyst in the forearm","volume":"6","author":"Reiser","year":"2024","unstructured":"Reiser DSzallasi ASagerfors M.Intraneural ulnar nerve ganglion: a surgical case report of a 10-cm-long recurring ganglion cyst in the forearm. Case Rep Orthop Res. 2024;6(1):39-44."},{"key":"bib3","series-title":"J Bone Joint Surg Br","first-page":"784","article-title":"Intraneural ganglion of the lateral popliteal nerve","volume":"43-B","author":"Parkes","year":"1961","unstructured":"Parkes A.Intraneural ganglion of the lateral popliteal nerve. J Bone Joint Surg Br. 1961;43-B:784-790."},{"issue":"5","key":"bib4","series-title":"Ultraschall Med","first-page":"556","article-title":"A rare case of Guyon\u2019s canal syndrome caused by cystic adventitia degeneration: high-resolution ultrasound findings","volume":"38","author":"Pivec","year":"2017","unstructured":"Pivec CSillat TMoritz TRiegler GNanobachvili JBodner G.A rare case of Guyon\u2019s canal syndrome caused by cystic adventitia degeneration: high-resolution ultrasound findings. Ultraschall Med. 2017;38(5):556-557."},{"issue":"4","key":"bib5","series-title":"Acta Sci Orthop","first-page":"33","article-title":"Adventitial cyst in ulner artery and palmar superficial arch of the hand\u2014a case report","volume":"3","author":"Alba","year":"2020","unstructured":"Alba JMPArteaga PS.Adventitial cyst in ulner artery and palmar superficial arch of the hand\u2014a case report. Acta Sci Orthop. 2020;3(4):33-37."},{"issue":"1","key":"bib6","series-title":"Case Rep Orthop Res","first-page":"33","article-title":"Ulnar nerve compression in Guyon\u2019s canal by ulnar artery cystic adventitial disease: a case report","volume":"4","author":"Afonso","year":"2021","unstructured":"Afonso JRCarvas JQuesado MUlnar nerve compression in Guyon\u2019s canal by ulnar artery cystic adventitial disease: a case report. Case Rep Orthop Res. 2021;4(1):33-38."},{"issue":"10","key":"bib7","series-title":"Skelet Radiol","first-page":"734","article-title":"Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a coincidental relationship supporting an articular theory","volume":"35","author":"Spinner","year":"2006","unstructured":"Spinner RJScheithauer BWDesy NMRock MGHoldt FCAmrami KK.Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a coincidental relationship supporting an articular theory. 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J Foot Ankle Surg. 2017;56(2):415-416."},{"issue":"2","key":"bib1","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."},{"issue":"1","key":"bib2","series-title":"Case Rep Orthop Res","first-page":"39","article-title":"Intraneural ulnar nerve ganglion: a surgical case report of a 10-cm-long recurring ganglion cyst in the forearm","volume":"6","author":"Reiser","year":"2024","unstructured":"Reiser DSzallasi ASagerfors M.Intraneural ulnar nerve ganglion: a surgical case report of a 10-cm-long recurring ganglion cyst in the forearm. Case Rep Orthop Res. 2024;6(1):39-44."},{"key":"bib3","series-title":"J Bone Joint Surg Br","first-page":"784","article-title":"Intraneural ganglion of the lateral popliteal nerve","volume":"43-B","author":"Parkes","year":"1961","unstructured":"Parkes A.Intraneural ganglion of the lateral popliteal nerve. J Bone Joint Surg Br. 1961;43-B:784-790."},{"issue":"5","key":"bib4","series-title":"Ultraschall Med","first-page":"556","article-title":"A rare case of Guyon\u2019s canal syndrome caused by cystic adventitia degeneration: high-resolution ultrasound findings","volume":"38","author":"Pivec","year":"2017","unstructured":"Pivec CSillat TMoritz TRiegler GNanobachvili JBodner G.A rare case of Guyon\u2019s canal syndrome caused by cystic adventitia degeneration: high-resolution ultrasound findings. Ultraschall Med. 2017;38(5):556-557."},{"issue":"4","key":"bib5","series-title":"Acta Sci Orthop","first-page":"33","article-title":"Adventitial cyst in ulner artery and palmar superficial arch of the hand\u2014a case report","volume":"3","author":"Alba","year":"2020","unstructured":"Alba JMPArteaga PS.Adventitial cyst in ulner artery and palmar superficial arch of the hand\u2014a case report. Acta Sci Orthop. 2020;3(4):33-37."},{"issue":"1","key":"bib6","series-title":"Case Rep Orthop Res","first-page":"33","article-title":"Ulnar nerve compression in Guyon\u2019s canal by ulnar artery cystic adventitial disease: a case report","volume":"4","author":"Afonso","year":"2021","unstructured":"Afonso JRCarvas JQuesado MUlnar nerve compression in Guyon\u2019s canal by ulnar artery cystic adventitial disease: a case report. Case Rep Orthop Res. 2021;4(1):33-38."},{"issue":"10","key":"bib7","series-title":"Skelet Radiol","first-page":"734","article-title":"Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a coincidental relationship supporting an articular theory","volume":"35","author":"Spinner","year":"2006","unstructured":"Spinner RJScheithauer BWDesy NMRock MGHoldt FCAmrami KK.Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a coincidental relationship supporting an articular theory. 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J Foot Ankle Surg. 2017;56(2):415-416."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/1\/article-CASE25618.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/1\/article-CASE25618.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/1\/article-CASE25618.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:07Z","timestamp":1776094027000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/1\/article-CASE25618.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":18,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/case25618","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}