{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:00:56Z","timestamp":1784682056849,"version":"3.55.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"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":[[2026,7,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cystic adventitial disease (CAD) and intraneural ganglion cysts (IGCs) are rare mucinous lesions typically linked to an articular origin via macroscopic conduits. While secondary propagation between vascular and neural systems may occur through shared fascial sheaths, a direct microvascular route has not been previously described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 60-year-old man presented with progressive left tibial neuropathy. High-resolution 7T MRI and surgery revealed a large popliteal CAD lesion connecting to the knee joint via the middle genicular artery, alongside a secondary tibial IGC lacking an independent articular nerve connection. Findings demonstrated that high-pressure CAD mucin tracked along a small connecting vascular branch, creating a novel microvascular arterio-neural pathway to infiltrate the tibial nerve. Targeted articular branch disconnection and cyst decompression yielded significant clinical improvement, with no recurrence on 7-month follow-up 7T MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case expands the unifying articular theory, demonstrating that synovial fluid propagation can exploit a microvascular arterio-neural pathway rather than strictly macroscopic fascial planes. High-resolution 7T MRI is essential for visualizing these subtle connections. Successful management requires meticulous identification and disconnection of the primary joint connection to prevent recurrence.<\/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\/CASE26411\">https:\/\/thejns.org\/doi\/10.3171\/CASE26411<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26411","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:10Z","timestamp":1784678470000},"source":"Crossref","is-referenced-by-count":0,"title":["A novel microvascular arterio-neural pathway for intraneural ganglion cyst formation secondary to cystic adventitial disease: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-3502","authenticated-orcid":true,"given":"Nontaphon","family":"Piyawattanametha","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Mayo Clinic, Rochester, Minnesota"},{"name":"Neurosurgery Unit, Division of Surgery, Khon Kaen University, Khon Kaen, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Marek","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Mayo Clinic, Rochester, Minnesota"},{"name":"Radiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godard C. W.","family":"de Ruiter","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":true,"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, CEU-San-Pablo University School of Medicine, Madrid, Spain"},{"name":"Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida"}],"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":"Manju","family":"Kalra","sequence":"additional","affiliation":[{"name":"Vascular Surgery, 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":"Departments of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10","key":"bib1","series-title":"Skeletal Radiol","first-page":"734","article-title":"Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a \u00adcoincidental 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 \u00adcoincidental relationship supporting an articular theory. Skeletal Radiol. 2006;35(10):734-744. doi:10.1007\/s00256-006-0148-7"},{"issue":"2","key":"bib2","series-title":"Clin Anat","first-page":"267","article-title":"Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint-connected","volume":"26","author":"Spinner","year":"2013","unstructured":"Spinner RJDesy NMAgarwal GPawlina WKalra MAmrami KK.Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint-connected. Clin Anat. 2013;26(2):267-281. doi:10.1002\/ca.22152"},{"issue":"3","key":"bib3","series-title":"J Neurosurg","first-page":"615","article-title":"Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature","volume":"125","author":"Desy","year":"2016","unstructured":"Desy NMWang HElshiekh MAIIntraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg. 2016;125(3):615-630. doi:10.3171\/2015.9.JNS141368"},{"key":"bib4","series-title":"J Med Case Rep","first-page":"91","article-title":"Involvement of the genicular branches in cystic adventitial disease of the popliteal artery as a possible marker of unfavourable early clinical outcome: a case report","volume":"4","author":"Ypsilantis","year":"2010","unstructured":"Ypsilantis EATisi PV.Involvement of the genicular branches in cystic adventitial disease of the popliteal artery as a possible marker of unfavourable early clinical outcome: a case report. J Med Case Rep. 2010;4:91. doi:10.1186\/1752-1947-4-91"},{"issue":"1","key":"bib5","series-title":"Vasc Endovascular Surg","first-page":"5","article-title":"A contemporary review of cystic adventitial disease","volume":"46","author":"Paravastu","year":"2012","unstructured":"Paravastu SCVRegi JMTurner DRGaines PA.A contemporary review of cystic adventitial disease. Vasc Endovascular Surg. 2012;46(1):5-14. doi:10.1177\/1538574411419377"},{"issue":"4","key":"bib6","series-title":"Ann Vasc Surg","first-page":"1062","article-title":"Cystic adventitial degeneration of the popliteal artery: report on 3 cases and review of the literature","volume":"28","author":"Hern\u00e1ndez Mateo","year":"2014","unstructured":"Hern\u00e1ndez Mateo MMSerrano Hernando FJMart\u00ednez L\u00f3pez ICystic adventitial degeneration of the popliteal artery: report on 3 cases and review of the literature. Ann Vasc Surg. 2014;28(4):1062-1069. doi:10.1016\/j.avsg.2013.09.013"},{"issue":"2","key":"bib7","series-title":"J Neurosurg","first-page":"296","article-title":"Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory","volume":"107","author":"Spinner","year":"2007","unstructured":"Spinner RJAmrami KKWolanskyj APDynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg. 2007;107(2):296-307. doi:10.3171\/JNS-07\/08\/0296"},{"issue":"1","key":"bib8","series-title":"Skeletal Radiol","first-page":"79","article-title":"Sequential tibial and peroneal intraneural ganglia arising from the superior tibiofibular joint","volume":"37","author":"Spinner","year":"2008","unstructured":"Spinner RJDesy NMAmrami KK.Sequential tibial and peroneal intraneural ganglia arising from the superior tibiofibular joint. 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Clin Anat. 2011;24(7):893-902. doi:10.1002\/ca.21190"},{"issue":"7","key":"bib14","series-title":"Clin Anat","first-page":"829","article-title":"An anatomic explanation for combined so-called adventitial\/intraneural cysts","volume":"28","author":"Prasad","year":"2015","unstructured":"Prasad NKHowe BMAmrami KKSpinner RJ.An anatomic explanation for combined so-called adventitial\/intraneural cysts. Clin Anat. 2015;28(7):829-832. doi:10.1002\/ca.22538"},{"issue":"4","key":"bib16","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(4):784-790. doi:10.1302\/0301-620X.43B4.784"},{"issue":"5363","key":"bib15","series-title":"Br Med J","article-title":"Cystic degeneration","volume":"2","author":"Richards","year":"1963","unstructured":"Richards RL.Cystic degeneration. Br Med J. 1963;2(5363):997. doi:10.1136\/bmj.2.5363.997-a"},{"issue":"3","key":"bib17","series-title":"Clin Anat","first-page":"233","article-title":"Patterns of intraneural ganglion cyst descent","volume":"21","author":"Spinner","year":"2008","unstructured":"Spinner RJCarmichael SWWang HParisi TJSkinner JAAmrami KK.Patterns of intraneural ganglion cyst descent. Clin Anat. 2008;21(3):233-245. doi:10.1002\/ca.20614"},{"issue":"4","key":"bib18","series-title":"Clin Anat","first-page":"461","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. 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Arch Neurol Psychiatry. 1945;54:283-289. doi:10.1001\/archneurpsyc.1945.02300100057006"},{"issue":"8","key":"bib20","series-title":"Clin Anat","first-page":"992","article-title":"The normal and pathologic MRI appearance of the tibialis anterior proximal motor branch","volume":"23","author":"H\u00e9bert-Blouin","year":"2010","unstructured":"H\u00e9bert-Blouin MNAmrami KKSpinner RJ.The normal and pathologic MRI appearance of the tibialis anterior proximal motor branch. Clin Anat. 2010;23(8):992-999. doi:10.1002\/ca.21032"},{"issue":"2","key":"bib21","series-title":"J Neurosurg","first-page":"334","article-title":"Recurrent intraneural ganglion cyst of the tibial nerve. Case report","volume":"92","author":"Spinner","year":"2000","unstructured":"Spinner RJAtkinson JLHarper CMJrWenger DE.Recurrent intraneural ganglion cyst of the tibial nerve. Case report. J Neurosurg. 2000;92(2):334-337. doi:10.3171\/jns.2000.92.2.0334"},{"issue":"6","key":"bib22","series-title":"J Neurosurg","first-page":"1653","article-title":"Extreme subparaneurial ganglion cysts. Part 2: The geyser theory as a mechanistic explanation for crossover","volume":"143","author":"de Ruiter","year":"2025","unstructured":"de Ruiter GCWReina MAHowe BMExtreme subparaneurial ganglion cysts. Part 2: The geyser theory as a mechanistic explanation for crossover. J Neurosurg. 2025;143(6):1653-1666. doi:10.3171\/2025.2.JNS242816"},{"issue":"6","key":"bib23","series-title":"J Neurosurg","first-page":"1642","article-title":"Extreme subparaneurial ganglion cysts. Part 1: Principles and implications","volume":"143","author":"de Ruiter","year":"2025","unstructured":"de Ruiter GCWSon BCHayford KMExtreme subparaneurial ganglion cysts. Part 1: Principles and implications. 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Acta Neurochir (Wien). 2023;165(11):3549-3558. doi:10.1007\/s00701-023-05724-1"},{"issue":"7","key":"bib26","series-title":"Clin Anat","first-page":"611","article-title":"Intraneural ganglion cyst: a 200-year-old mystery solved","volume":"21","author":"Spinner","year":"2008","unstructured":"Spinner RJVincent JFWolanskyj APScheithauer BW.Intraneural ganglion cyst: a 200-year-old mystery solved. Clin Anat. 2008;21(7):611-618. doi:10.1002\/ca.20709"},{"issue":"6","key":"bib27","series-title":"Neurosurgery","first-page":"1291","article-title":"The first described joint-associated intraneural ganglion cyst","volume":"69","author":"Spinner","year":"2011","unstructured":"Spinner RJWang H.The first described joint-associated intraneural ganglion cyst. Neurosurgery. 2011;69(6):1291-1298. doi:10.1227\/NEU.0b013e3182237299"},{"issue":"3","key":"bib28","series-title":"Hand (N Y)","first-page":"317","article-title":"Case report: intraneural ganglion cyst of the ulnar nerve at the wrist","volume":"6","author":"Colbert","year":"2011","unstructured":"Colbert SHLe MH.Case report: intraneural ganglion cyst of the ulnar nerve at the wrist. 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