Intraneural ganglia in the hip and pelvic region

Clinical article

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  • 1 Departments of Neurologic Surgery,
  • 2 Orthopedics, and
  • 3 Radiology, Mayo Clinic, Rochester, Minnesota;
  • 4 University of Calgary, Department of Clinical Neurosciences and Hotchkiss Brain Institute Calgary, Alberta, Canada;
  • 5 New York University, Langone Medical Center, Departments of Neurosurgery and Orthopedic Surgery, New York, New York; and Ushioda General Hospital,
  • 6 Departments of Neurosurgery and
  • 7 Orthopedic Surgery, Kanagawa, Japan
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Object

The authors describe their experience in a series of cases of intraneural ganglia within the hip and pelvic regions, and explain the mechanism of formation and propagation of this pathological entity.

Methods

Five patients with 6 intraneural ganglia are presented. Four patients presented with symptomatic intraneural ganglia in the buttock and pelvis affecting the sciatic and lumbosacral plexus elements. An asymptomatic cyst affecting the opposite sciatic nerve was found on MR imaging in 1 patient. The fifth patient, previously reported on by another group, had an obturator intraneural ganglion that the authors reinterpreted.

Results

All 5 intraneural ganglia affecting the sciatic and lumbosacral plexus elements were found to have a joint connection to the posteromedial aspect of the hip joint; the obturator intraneural cyst had a joint connection to the anteromedial aspect of the hip joint. In all cases, initial review of the MR images led to their misinterpretation.

Conclusions

To the authors' knowledge, these are the first cases of intraneural ganglia demonstrated to have a connection to the hip joint. This finding at a rare site provides further evidence for the unifying articular (synovial) theory for the formation of intraneural ganglia and reveals a shared mechanism for their propagation. Furthermore, understanding the pathogenesis of these lesions provides insight into their successful treatment and their recurrence.

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Contributor Notes

Address correspondence to: Robert J. Spinner, M.D., Department of Neurosurgery, 200 First Street SW, Mayo Clinic Rochester, Minnesota 55905. email: spinner.robert@mayo.edu.
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