Does complete regression of intraneural ganglion cysts occur without surgery?

Autor: Lenartowicz KA; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA., Murthy NK; Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA., Desy NM; Department of Orthopedics, University of Calgary, Alberta, Calgary, Canada., De La Pena NM; Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA., Wolf AS; Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA., Wilson TJ; Stanford University Medical Center, Stanford, CA, USA., Amrami KK; Department of Radiology, Mayo Clinic, Rochester, MN, USA., Spinner RJ; Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. spinner.robert@mayo.edu.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2022 Oct; Vol. 164 (10), pp. 2689-2698. Date of Electronic Publication: 2022 Jul 25.
DOI: 10.1007/s00701-022-05311-w
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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