Sciatic cross-over in patients with peroneal and tibial intraneural ganglia confirmed by knee MR arthrography

Robert J. Spinner, Huan Wang, Marie Noëlle Hébert-Blouin, John A. Skinner, Kimberly K. Amrami

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: A predictable mechanism and stereotypic patterns of peroneal intraneural ganglia are being defined based on careful analysis of MRIs. Peroneal and tibial intraneural ganglia extending from the superior tibiofibular joint which extend to the level of the sciatic nerve have been observed leading to the hypothesis that sciatic cross-over could exist. Such a cross-over phenomenon would allow intraneural cyst from the peroneal nerve by means of its shared epineurial sheath within the sciatic nerve to cross over to involve the tibial nerve, or vice versa from a tibial intraneural cyst to the peroneal nerve. Method and Findings: One patient with a peroneal intraneural ganglion and another with a tibial intraneural ganglion each underwent a knee MR arthrogram. These studies were not only definitive in demonstrating the communication of the cyst to the superior tibiofibular joint connection but also in confirming sciatic cross-over. Contrast injected into the knee could be demonstrated tracking to the superior tibiofibular joint and then proximally into the common peroneal or tibial nerve respectively, crossing over at the sciatic nerve, and then descending down the tibial and peroneal nerves. The arthrographic findings mirrored MR images upon their retrospective review. Conclusions: This study provides direct in vivo proof of the nature of sciatic cross-over theorized by critical review of MRIs and/or experimental dye injections done in cadavers. This study is important in clarifying the potential paths of propagation of intraneural cysts at points of major bifurcation.

Original languageEnglish (US)
Pages (from-to)89-98
Number of pages10
JournalActa Neurochirurgica
Volume151
Issue number1
DOIs
StatePublished - Jan 1 2009

Keywords

  • Articular branch
  • MR arthrography
  • Peroneal nerve ganglion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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