{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:58:03Z","timestamp":1788692283400,"version":"build-2803163510"},"reference-count":43,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2007,8]]},"abstract":"\n Object<\/jats:title>\n The pathogenesis of intraneural ganglia has been a controversial issue for longer than a century. Recently the authors identified a stereotypical pattern of occurrence of peroneal and tibial intraneural ganglia, and based on an understanding of their pathogenesis provided a unifying articular explanation. Atypical features, which occasionally are observed, have offered an opportunity to verify further and expand on the authors' proposed theory.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Three unusual cases are presented to exemplify the dynamic features of peroneal and tibial intraneural ganglia formation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Two patients with a predominant deep peroneal nerve deficit shared essential anatomical findings common to peroneal intraneural ganglia: namely, 1) joint connections to the anterior portion of the superior tibiofibular joint, and 2) dissection of the cyst along the articular branch of the peroneal nerve and proximally. Magnetic resonance (MR) images obtained in these patients demonstrated some unusual findings, including the presence of a cyst within the tibial and sural nerves in the popliteal fossa region, and spontaneous regression of the cysts, which was observed on serial images obtained weeks apart. The authors identified a clinical outlier, a case that could not be understood within the context of their previously reported theory of intraneural ganglion cyst formation. Described 32 years ago, this patient had a tibial neuropathy and was found at surgery to have tibial, peroneal, and sciatic intraneural cysts without a joint connection. The authors' hypothesis about this case, based on their unified theory, was twofold: 1) the lesion was a primary tibial intraneural ganglion with proximal extension followed by sciatic cross-over and distal descent; and 2) a joint connection to the posterior aspect of the superior tibiofibular joint with a remnant cyst within the articular branch would be present, a finding that would help explain the formation of different cysts by a single mechanism. The authors proved their hypothesis by careful inspection of a recently obtained postoperative MR image.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These three cases together with data obtained from a retrospective review of the authors' clinical material and findings reported in the literature provide firm evidence for mechanisms underlying intraneural ganglia formation. Thus, expansion of the authors' unified articular theory permits understanding and elucidation of unusual presentations of intraneural cysts. Whereas an articular connection and fluid following the path of least resistance was pivotal, the authors now incorporate dynamic aspects of cyst formation due to pressure fluxes. These basic principles explain patterns of ascent, cross-over, and descent down terminal nerve branches based on articular connections, paths of diminished resistance to fluid flow within recognized anatomical compartments, and the effects of fluctuating pressure gradients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/jns-07\/08\/0296","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T07:50:52Z","timestamp":1201161052000},"page":"296-307","source":"Crossref","is-referenced-by-count":86,"title":["Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory"],"prefix":"10.3171","volume":"107","author":[{"given":"Robert J.","family":"Spinner","sequence":"first","affiliation":[{"name":"Departments of Neurologic Surgery,"},{"name":"Orthopedics,"},{"name":"Anatomy,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra P.","family":"Wolanskyj","sequence":"additional","affiliation":[{"name":"Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M.","family":"Desy","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"},{"name":"McGill University School of Medicine, Montreal, Quebec, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"},{"name":"Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo E.","family":"Benarroch","sequence":"additional","affiliation":[{"name":"Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Skinner","sequence":"additional","affiliation":[{"name":"Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Rock","sequence":"additional","affiliation":[{"name":"Orthopedics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd W.","family":"Scheithauer","sequence":"additional","affiliation":[{"name":"Anatomic Pathology, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1070296","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s003810050216","article-title":"Intraneural cyst of the peroneal nerve","volume":"14","author":"Aulisa","year":"1998"},{"key":"b2-1070296","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00256-005-0031-y","article-title":"An unusual variant of intraneural ganglion of the common peroneal nerve","volume":"35","author":"Bonar","year":"2006"},{"key":"b3-1070296","series-title":"Ann Vasc Surg","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/S10016-006-9066-3","article-title":"\u201cIntermittent claudication intermittence\u201d as a manifestation of adventitial cystic disease communicating with the knee joint\u201d","volume":"20","author":"Buijsrogge","year":"2006"},{"key":"b4-1070296","series-title":"Spine","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1097\/00007632-200003150-00016","article-title":"Synovial cyst of the transverse ligament of the atlas in a patient with os odontoideum and atlantoaxial instability","volume":"25","author":"Chang","year":"2000"},{"key":"b5-1070296","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3171\/spi.2006.4.2.186","article-title":"Spontaneous resolution of a cervical synovial cyst. Case illustration","volume":"4","author":"Colen","year":"2006"},{"key":"b6-1070296","series-title":"JBR-BTR","first-page":"141","article-title":"[Computed tomography diagnosis of clinically well-tolerated bilateral vertebral synovial cysts.]","volume":"81","author":"Coulier","year":"1998"},{"key":"b7-1070296","series-title":"J Shoulder Elbow Surg","first-page":"E4","article-title":"Spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy: a case report","volume":"3","author":"Davidge","year":"2007"},{"key":"b8-1070296","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s00276-004-0284-5","article-title":"Anterior innervation of the proximal tibio-fibular joint","volume":"27","author":"de Seze","year":"2005"},{"key":"b9-1070296","series-title":"Ceska a Slovenska Neurologie a Neurochirurgie","first-page":"300","article-title":"[Relapsing intraneural ganglion of the n. peroneus comm.]","volume":"64","author":"Dr\u00e1bek","year":"2001"},{"key":"b10-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"280","DOI":"10.3171\/jns.1996.84.2.0280","article-title":"Recurrent ganglion cyst of the peroneal nerve: radiological and operative observations. Case report","volume":"84","author":"Dubuisson","year":"1996"},{"key":"b11-1070296","series-title":"Zentralbl Neurochir","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1055\/s-2005-836475","article-title":"Resolution of a synovial cyst of the lumbar spine without surgical therapy\u2014a case report","volume":"66","author":"Ewald","year":"2005"},{"key":"b12-1070296","series-title":"J Bone Joint Surg (Am)","doi-asserted-by":"publisher","first-page":"519","DOI":"10.2106\/00004623-196749030-00011","article-title":"Intraneural ganglion of the tibial nerve. A case report","volume":"49","author":"Friedlander","year":"1967"},{"key":"b13-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3171\/jns.1997.87.3.0403","article-title":"Ganglion cyst involvement of peripheral nerves","volume":"87","author":"Harbaugh","year":"1997"},{"issue":"2 Suppl","key":"b14-1070296","series-title":"J Neurosurg","first-page":"235","article-title":"Spontaneous regression of symptomatic lumbar synovial cysts. Report of three cases","volume":"99","author":"Houten","year":"2003"},{"key":"b15-1070296","series-title":"Clin Orthop Relat Res","first-page":"135","article-title":"Ganglia of the nerve. Presentation of two unusual cases, a review of the literature, and a discussion of pathogenesis","volume":"113","author":"Jacobs","year":"1975"},{"key":"b16-1070296","series-title":"Ann Rheum Dis","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/ard.31.1.9","article-title":"Popliteal and calf cysts in rheumatoid arthritis. Treatment by anterior synovectomy","volume":"31","author":"Jayson","year":"1972"},{"key":"b17-1070296","series-title":"Br J Plast Surg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0007-1226(03)00036-5","article-title":"Intraneural ganglion cysts: a case of sciatic nerve involvement","volume":"56","author":"Krishnan","year":"2003"},{"key":"b18-1070296","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1136\/jnnp.57.7.870-a","article-title":"Intraneural ganglion of the sciatic nerve: detection by ultrasound","volume":"57","author":"Lang","year":"1994"},{"key":"b19-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"120","DOI":"10.3171\/jns.1974.40.1.0120","article-title":"Ganglion of the posterior tibial nerve. Case report","volume":"40","author":"Mahaley","year":"1974"},{"key":"b20-1070296","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1007\/BF00339570","article-title":"Intraspinal synovial cyst: diagnosis by CT. Follow-up and spontaneous remission","volume":"27","author":"Mercader","year":"1985"},{"key":"b21-1070296","series-title":"Microreconstruction of Nerve Injuries","first-page":"3","article-title":"Nomenclature in peripheral nerve surgery","author":"Millesi","year":"1987"},{"key":"b22-1070296","series-title":"Spine","doi-asserted-by":"publisher","first-page":"E492","DOI":"10.1097\/01.BRS.0000099095.21233.5C","article-title":"Intraspinal synovial cyst communicating with the C1\u2013C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability","volume":"28","author":"Morio","year":"2003"},{"key":"b23-1070296","series-title":"Knee Surg Sports Traumatol Arthrosc","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1007\/s00167-005-0021-6","article-title":"Proximal tibiofibular joint synovial cyst\u2014one pathology with three different presentations","volume":"14","author":"Mortazavi","year":"2006"},{"key":"b24-1070296","series-title":"Eur J Vasc Surg","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/S0950-821X(05)80216-6","article-title":"Cystic adventitial disease of the popliteal artery\u2014a case of spontaneous resolution","volume":"4","author":"Owen","year":"1990"},{"key":"b25-1070296","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1007\/s004150200048","article-title":"Fluctuating peroneal nerve palsy caused by an intraneural cyst","volume":"249","author":"Petit-Lacour","year":"2002"},{"key":"b26-1070296","series-title":"J R Soc Med","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/014107680409700208","article-title":"Spontaneous and permanent resolution of cystic adventitial disease of the popliteal artery","volume":"97","author":"Pursell","year":"2004"},{"key":"b27-1070296","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"143","article-title":"[Nerve compression by mucoid pseudocysts: arguments favoring an articular cause in 23 patients.]","volume":"90","author":"Rezzouk","year":"2004"},{"key":"b28-1070296","series-title":"J Mal Vasc (Paris)","first-page":"323","article-title":"[Spontaneous regression of a sub-adventitial cyst of the popliteal artery.]","volume":"20","author":"Soury","year":"1995"},{"issue":"6","key":"b29-1070296","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments","volume":"22","author":"Spinner","year":"2007"},{"key":"b30-1070296","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1007\/s00256-005-0036-6","article-title":"The use of MR arthrography to document an occult joint communication in a recurrent peroneal intraneural ganglion","volume":"35","author":"Spinner","year":"2006"},{"key":"b31-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"334","DOI":"10.3171\/jns.2000.92.2.0334","article-title":"Recurrent intraneural ganglion cyst of the tibial nerve. Case report","volume":"92","author":"Spinner","year":"2000"},{"key":"b32-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"319","DOI":"10.3171\/jns.2003.99.2.0319","article-title":"Peroneal intraneural ganglia: the importance of the articular branch. Clinical series","volume":"99","author":"Spinner","year":"2003"},{"key":"b33-1070296","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3171\/jns.2003.99.2.0330","article-title":"Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory","volume":"99","author":"Spinner","year":"2003"},{"key":"b34-1070296","series-title":"Neurosurgery","first-page":"157","article-title":"Cystic transverse limb of the articular branch: a pathognomonic sign for peroneal intraneural ganglia at the superior tibiofibular joint","volume":"59","author":"Spinner","year":"2006"},{"key":"b35-1070296","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1007\/s00256-006-0213-2","article-title":"The clinico-anatomic explanation for tibial intra-neural ganglion cysts arising from the superior tibiofibular joint","volume":"36","author":"Spinner","year":"2007"},{"key":"b36-1070296","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1007\/s00256-006-0148-7","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"},{"key":"b37-1070296","series-title":"Clin Anat","article-title":"Epineurial compartments and their role in intraneural ganglion cyst propagation: an experimental study","author":"Spinner","year":"2007"},{"key":"b38-1070296","series-title":"Nerve Injuries and Repairs","first-page":"13","author":"Sunderland","year":"1991"},{"key":"b39-1070296","series-title":"AJNR Am J Neuroradiol","first-page":"1261","article-title":"Spontaneous resolution of an intraspinal synovial cyst","volume":"24","author":"Swartz","year":"2003"},{"key":"b40-1070296","series-title":"Knee Surg Sports Traumatol Arthrosc","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1007\/s00167-006-0062-5","article-title":"Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report","volume":"14","author":"Tseng","year":"2006"},{"key":"b41-1070296","series-title":"Anesth Analg","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1213\/00000539-199702000-00028","article-title":"A common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block","volume":"84","author":"Vloka","year":"1997"},{"key":"b42-1070296","series-title":"Acta Orthop Scand","first-page":"221","article-title":"Two cases of ganglia in the sheath of the peroneal nerve","volume":"2","author":"Wadstein","year":"1931"},{"key":"b43-1070296","series-title":"J Bone Joint Surg (Am)","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.2106\/00004623-197254050-00011","article-title":"Popliteal cysts An arthrographic study and review of the literature","volume":"54","author":"Wolfe","year":"1972"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/2\/article-p296.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/2\/article-p296.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/2\/article-p296.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T05:12:27Z","timestamp":1709961147000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/2\/article-p296.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,8]]},"references-count":43,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/jns-07\/08\/0296","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2007,8]]}}}