Intraneural Ganglion of the Tibial Nerve

Tibial sinirin gangliyon kistleri çok nadirdir. Bu çalışmada, bilek ekleminin posteromedial kısmında belirgin bir kitle olan, 24 yaşındaki bir erkek hasta olgusu sunmak istedik. Hasta, ayağının plantar ve medial yüzeyinde aralıklı, hafif ve belirsiz bir uyuşma hissinden bahsetmekteydi. Manyetik rezonans görüntülemesi tarsal tunneldeki kistin varlığını göstermiştir. Cerrahi sırasında, siniri çevreleyen derinin hemen yanında kapsülle çevrili bir kist varlığıyla karşılaştık. Diseksiyon esnasında, kistin intranöral olarak invaze olduğunu tespit ettik. Kist, mikrocerrahi teknikleri kullanılarak, sinirin perinöral ve intrafasiküler olarak diseksiyonu ile başarıyla çıkarıldı. Hasta, cerrahiden sonra semptomlarından kurtuldu.
Anahtar Kelimeler:

Gangliyon, posterior, tibial sinir

Intraneural Ganglion of the Tibial Nerve

Ganglion cysts of tibial nerve is very rare. We present a 24 y/o male with a prominent mass at the posteromedial side of the ankle joint. He experienced an intermittent mild numbness and vague pain at the plantar and medial surface of his foot. Magnetic resonance imaging showed the presence of the cyst within the tarsal tunnel. During surgery, an encapsulated cyst is found just beneath the skin which surrounds the nerve. During dissection, we realized the intraneural invasion of cyst. The cyst was successfully removed by dissecting the nerve perineurally and intrafaciculary with microsurgical techniques. The patient was freed from symptoms after surgery. 

___

  • 1. Scherman BM, Bilbao JM, Hudson AR, Briggs SJ, Intraneural ganglion: a case report with electron microscopic observations. Neurosurgery. 1981 Apr;8(4):487-90.
  • 2. Spinner RJ, Desy NM, Rock MG, Amrami KK. Peroneal intraneural ganglia. Part I. Techniques for successful diagnosis and treatment. Neurosurg Focus. 2007 Jun 15;22(6):E16.
  • 3. Fujita I, Matsumoto K, Minami T, Kizaki T, Akisue T, Yamamoto T. Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve: report of 2 cases and review of the literature. J Foot Ankle Surg. 2004 MayJun;43(3):185-90. Review.
  • 4. Boyer MI, Hochban T, Bowen V. Tarsal tunnel syndrome: an unusual case resulting from an intraneural degenerative cyst. Can J Surg. 1995 Aug;38(4): 371-3.
  • 5. Gosk J, Rutowski R, Urban M, Reichert P, Rabczyński J. Intraneural ganglion of the tibial nerve--a case report. Neurol Neurochir Pol. 2007 Mar-Apr;41(2):176-80; discussion 180.