Karina A Lenartowicz1, Nikhil K Murthy2, Nicholas M Desy3, Nicole M De La Pena4, Alexandre S Wolf2, Thomas J Wilson5, Kimberly K Amrami6, Robert J Spinner7. 1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA. 2. Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. 3. Department of Orthopedics, University of Calgary, Alberta, Calgary, Canada. 4. Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA. 5. Stanford University Medical Center, Stanford, CA, USA. 6. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 7. Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. spinner.robert@mayo.edu.
Abstract
PURPOSE: The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention. METHODS: We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection. RESULTS: We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases. CONCLUSION: We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.
PURPOSE: The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention. METHODS: We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection. RESULTS: We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases. CONCLUSION: We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.
Authors: Nicholas M Desy; Huan Wang; Mohanad Ahmed Ibrahim Elshiekh; Shota Tanaka; Tae Woong Choi; B Matthew Howe; Robert J Spinner Journal: J Neurosurg Date: 2016-01-22 Impact factor: 5.115
Authors: Ekkapot Jitpun; Benjamin Matthew M Howe; Kimberly K Amrami; Robert T Trousdale; Robert J Spinner Journal: World Neurosurg Date: 2019-02-22 Impact factor: 2.104
Authors: Nels D Leafblad; Thomas J Wilson; Kimberly K Amrami; Norman S Turner; Robert J Spinner Journal: J Foot Ankle Surg Date: 2019-01-03 Impact factor: 1.286
Authors: Karina A Lenartowicz; Kimberly K Amrami; Jeffrey A Strakowski; B Matthew Howe; Robert J Spinner Journal: J Neurosurg Case Lessons Date: 2022-10-03