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
Acta Neurochirurgica 2009, 151 (1): 89-98

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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"