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المصدر: Clinical Anatomy. 21:111-118
مصطلحات موضوعية: Pathology, medicine.medical_specialty, Histology, Nerve root, Superior tibiofibular joint, Nerve Fibers, Upper trunk, Cadaver, Epineurium, Pressure, medicine, Humans, Cyst, Peripheral Nerves, Retrospective Studies, Ganglion Cysts, Neurons, Shoulder Joint, business.industry, General Medicine, Anatomy, Suprascapular nerve, medicine.disease, Magnetic Resonance Imaging, Scapula, medicine.anatomical_structure, Sciatic nerve, business
الوصف: The appearances of intraneural ganglion cysts are being elucidated. We previously introduced the cross-over phenomenon to explain how a fibular (peroneal) or tibial intraneural ganglion cyst arising from the superior tibiofibular joint could give rise to multiple cysts: cyst fluid ascending up the primarily affected nerve could reach the level of the sciatic nerve, fill its common epineurial sheath and spread circumferentially (cross over), at which time pressure fluxes could result in further ascent up the sciatic or descent down the same parent nerve or the opposite, previously unaffected fibular or tibial nerves. In this study, we hypothesized that cross-over could occur in other nerves, potentially leading to the formation of more than one intraneural ganglion cyst in such situations. We analyzed the literature and identified a single case that we could review where proximal extension of an intraneural ganglion cyst involving a nerve at a different site could theoretically undergo cross-over in another major nerve large enough for available magnetic resonance images to resolve this finding. A case of a suprascapular intraneural ganglion cyst previously reported by our group that arose from the glenohumeral joint and extended to the neck was reanalyzed for the presence or absence of cross-over. An injection of dye into the outer epineurium of the suprascapular nerve in a fresh cadaveric specimen was performed to test for cross-over experimentally. Retrospective review of this case of suprascapular intraneural ganglion cyst demonstrated evidence to support previously unrecognized cross-over at the level of the upper trunk, with predominant ascent up the C5 and the C6 nerve roots and subtle descent down the anterior and posterior divisions of the upper trunk as well as the proximal portion of the suprascapular nerve. This appearance gave rise to multiple interconnected intraneural ganglion cysts arising from a single distant connection to the glenohumeral joint. The injection study also demonstrated the cross-over phenomenon and produced a similar pattern as the cyst dissection. This article illustrates that cross-over can occur in another nerve (apart from the prototype fibular nerve). Furthermore, understanding the more complex anatomic nature of the upper trunk cross-over model provides insight into important mechanistic information regarding the bidirectional propagation patterns and formation of primary and secondary intraneural ganglion cysts not afforded by the previously described sciatic nerve cross-over model.
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المصدر: Neurosurgical Focus. 22:1-10
مصطلحات موضوعية: Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Radiography, Superior tibiofibular joint, Magnetic resonance imaging, General Medicine, Anatomy, Knee region, Ganglion, medicine.anatomical_structure, Epineurium, medicine, Surgery, Neurology (clinical), Sciatic nerve, business, Tibial nerve
الوصف: Object Previously the authors demonstrated that peroneal and tibial intraneural ganglia arising from the superior tibiofibular joint may occasionally extend proximally within the epineurium to reach the sciatic nerve. The dynamic nature of these cysts, dependent on intraarticular pressures, may give rise to differing clinical and imaging presentations that have remained unexplained until now. To identify the pathogenesis of these unusual cysts and to correlate their atypical magnetic resonance (MR) imaging appearance, the authors retrospectively reviewed their own experience as well as the published literature on these types of intraneural ganglia. Methods A careful review of MR images obtained in 22 patients with intraneural ganglia located about the knee region (18 peroneal and four tibial intraneural ganglia) allowed the authors to substantiate three different patterns: outer (epifascicular) epineurial (20 cases); inner (interfascicular) epineurial (one case); and combined outer and inner epineurial (one case). In these cases serial MR images allowed the investigators to track the movement of the cyst within the same layer of the epineurium. All lesions had connections to the superior tibiofibular joint. Nine patients were identified as having lesions with sciatic nerve extension. Seven patients harboring an outer epineurial cyst (six in whom the cyst involved the peroneal nerve and one in whom it involved the tibial nerve) had signs of sciatic nerve cross-over, with the cyst seen in the sciatic nerve and/or other terminal branches. In only two of these cases had the cyst previously been recognized to have sciatic nerve involvement. In contrast, in one case an inner epineurial cyst involving the tibial nerve ascended within the tibial division of the sciatic nerve and did not cross over. A single patient had a combination of both outer and inner epineurial cysts; these were easily distinguished by their distinctive imaging patterns. Conclusions This anatomical compartmentalization of intraneural cysts can be used to explain varied clinical and imaging patterns of cleavage planes for cyst formation and propagation. Compartmentalization elucidates the mechanism for cases of outer epineurial cysts in which there are primary ascent, sciatic cross-over, and descent of the lesion down terminal branches; correlates these cysts' atypical MR imaging features; and contrasts a different pattern of inner epineurial cysts in which ascent and descent occur without cross-over. The authors present data demonstrating that the dynamic phases of these intraneural ganglia frequently involve the sciatic nerve. Their imaging features are subtle and serve to explain the underrecognition and underreporting of the longitudinal extension of these cysts. Importantly, cysts extending to the sciatic nerve are still derived from the superior tibiofibular joint. Combined with the authors' previous experimental data, the current observations help the reader understand intraneural ganglia with a different, deeper degree of anatomical detail.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::9db771a1c2140a27f08260bc315f5080
https://doi.org/10.3171/foc.2007.22.6.18 -
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المؤلفون: Norman S. Turner, J. Michael Alcorn, Stephen W. Carmichael, David W. Stanley, John S. Reach, Joel P. Felmlee, Kimberly K. Amrami
المصدر: Clinical Anatomy. 20:201-208
مصطلحات موضوعية: Male, 3 Tesla Magnetic Resonance Imaging, Histology, medicine.diagnostic_test, Foot, business.industry, Interossei, Magnetic resonance imaging, General Medicine, Anatomy, Compartment Syndromes, Magnetic Resonance Imaging, medicine.anatomical_structure, Healthy volunteers, medicine, Humans, Female, Ankle, business, Foot (unit)
الوصف: There is neither consensus on the number nor agreement on the location of the anatomic compartments of the foot. This project utilized high-resolution magnetic resonance imaging (MRI) to identify foot compartments. The purpose of this study was to devise a new system using 3-Tesla (3T) MRI that assessed the number and location of these compartments. Six feet from healthy volunteers were imaged. From these, 10 compartments were described: (1) medial, (2) calcaneal, (3) lateral, (4) central superficial, (5) central deep (adductor), (6–9) interossei, and (10) skin. The 3T MRI and foot/ankle coil allowed us to assess the number and location of foot compartments. Clin. Anat. 20:201–208, 2007. © 2006 Wiley-Liss, Inc.
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المؤلفون: Stephen W. Carmichael, John L.D. Atkinson, Robert J. Spinner
المصدر: Journal of Neurosurgery. 104:990-992
مصطلحات موضوعية: Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Hypoglossal canal, Anatomy, medicine.disease, Cranial nerve involvement, Intraneural ganglion, Lesion, Skull, medicine.anatomical_structure, medicine, Cyst, medicine.symptom, business, Hypoglossal nerve
الوصف: An unusual case of an intraneural ganglion cyst of the hypoglossal nerve is presented. Only one case of this rare clinical entity has been reported previously. A 51-year-old woman presented with a 6-month history of left-sided hypoglossal nerve palsy. Magnetic resonance imaging revealed a cystic lesion related to the hypoglossal canal. There was no enhancement of the lesion after administration of Gd. A high-resolution computerized tomography scan of the skull base demonstrated an enlargement of the hypoglossal canal. To access the lesion, a far-lateral endoscope-assisted microsurgical approach was used. An intraneural ganglion lesion invading the hypoglossal nerve was found and resected. A histopathological examination confirmed that the lesion was an intraneural ganglion cyst. The occurrence of an intraneural ganglion cyst at the hypoglossal nerve is very rare. This case exemplifies an atypical location of a synovial cyst with cranial nerve involvement.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::f72cf604829c011a4dc39a6ef656bd39
https://doi.org/10.3171/jns.2006.104.6.990 -
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المؤلفون: Huan Wang, Thomas J. Parisi, John A. Skinner, Stephen W. Carmichael, Kimberly K. Amrami, Robert J. Spinner
المصدر: Clinical anatomy (New York, N.Y.). 21(3)
مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Histology, Knee Joint, Decompression, Superior tibiofibular joint, parasitic diseases, medicine, Humans, Cyst, Tibial nerve, Retrospective Studies, Ganglion Cysts, medicine.diagnostic_test, business.industry, Peroneal Nerve, Magnetic resonance imaging, General Medicine, Anatomy, musculoskeletal system, medicine.disease, Magnetic Resonance Imaging, Surgery, Ganglion cyst, medicine.anatomical_structure, Sciatic nerve, Tibial Nerve, business
الوصف: On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal branches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent nerve, and the terminal branches, although in three cases they were subclinical. The authors demonstrate that cyst descent distal to the take-off of the articular branch to the joint of origin occurs regularly in patients with fibular and tibial intraneural ganglion cysts. The authors believe that parent terminal branch descent follows ascent up the articular branch from an affected joint of origin. This mechanism for bidirectional flow explains cyst within terminal branches of the fibular and tibial nerves and is dependent on pressure fluxes and resistances. This new pattern is consistent with principles previously described in a unified (articular) theory, is generalizable to other intraneural ganglion cysts arising from joints, and has important implications for pathogenesis and treatment of these intraneural cysts.
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المؤلفون: Stephen W. Carmichael, Michael H. Bourne, Michael B. Wood
المصدر: The Journal of Hand Surgery. 12:697-699
مصطلحات موضوعية: medicine.medical_specialty, Lidocaine, business.industry, Magnetic resonance neurography, Cutaneous nerve, Impingement syndrome, Anatomy, medicine.disease, Magnetic Resonance Imaging, Musculocutaneous nerve, Surgery, medicine.anatomical_structure, Forearm, Musculocutaneous Nerve, medicine, Humans, Orthopedics and Sports Medicine, Anesthetics, Local, business, Radial nerve, Sensory nerve, medicine.drug
الوصف: Dissections of 20 antebrachial specimens were done to define the location of the proximal lateral antebrachial cutaneous nerve, which is the distal sensory extension of the musculocutaneous nerve. Our findings varied from those noted in most anatomic and surgical texts in that the nerve emerges from the lateral aspect of the biceps tendon at the level of the interepicondylar line. At the point defined, the distribution of the nerve in ten volunteers was successfully anesthetized with 1.5 ml of 1 % lidocaine. The accurate anatomic localization of this nerve should be of interest to surgeons and anesthesiologists in supplementing failed axillary blockade, in diagnosing and treating the musculocutaneous impingement syndrome, in harvesting the proximal nerve for diagnostic tests or donor graft purposes, and in differentiating the sensory distribution of this nerve from that of the radial nerve.
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