Resection Of Ganglion Research Articles

Endoscopic Resection of Horseshoe Ganglion of the Great Toe

Twelve percent of the foot ganglion cysts occur on the toes, and they are often symptomatic and recurrent. When conservative treatment failed, surgical excision is recommended, which is classically an open resection of the ganglion cyst. However, communicating lesions between ganglion cysts and the interphalangeal joint or tendon sheath make it difficult to prevent a recurrence. Techniques of arthroscopic or endoscopic toe ganglionectomy have been reported, which is either arthroscopic/endoscopic internal drainage to the adjacent joint or tendon sheath or endoscopic resection of the ganglion cyst. Difficulty in identifying the communicating valvular lesion and high incidence of multiloculated lesions make endoscopic internal drainage not always feasible for toe ganglion. The purpose of this Technical Note is to describe the details of endoscopic resection of horseshoe ganglion of the great toe. This minimal invasive approach may help to reduce the risk of recurrence.

Endoscopic Resection of Horseshoe Ganglion of the Lateral Midfoot

A ganglion is the most common soft-tissue mass in the foot and can cause pain, paresthesia, or footwear problems. A ganglion can extend from the dorsum into the plantar compartment of the foot in the form of a horseshoe at the borders of the foot or in the form of an hourglass through the intermetatarsal space. Initial conservative management of a ganglion may entail observation and the use of padding for comfort, manual rupture, aspiration of the cyst contents, and steroid injection or sclerotherapy into the cyst. When the lesion is recurrent or painful, surgical excision is recommended. The purpose of this Technical Note is to describe the details of endoscopic resection of a horseshoe ganglion of the lateral midfoot. This technique has the advantages of being minimally invasive, with better cosmetic results and less surgical trauma to the soft tissue.

Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis.

Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures. We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention. Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise. The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.

Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques

We compared arthroscopic cyst resection (ACR) of dorsal ganglia of the wrist, either associated to reconstruction of the dorsal capsuloligamentous scapholunate septum (ACR-DCSS) in 66 cases in which the ganglia were painful on exertion, or isolated ACR in 15 pain-free cases. A single-center retrospective study analyzed data for the period April 2013 to May 2021. The main aim was to compare pre- and post-operative functional results (pain at rest (on a numerical rating scale: NRS), pain under effort (NRS), range of motion (°), grip strength (kg)) and recurrence rate between the two techniques. The study hypothesis was that DCSS repair improves recurrence of dorsal ganglion cyst and functional outcome. The ACR-DCSS group showed significant improvement in extension, pronation, supination, radial inclination, ulnar inclination, grip strength, pain at rest and pain on exertion. The ACR group showed significant improvement in pronation, ulnar inclination and pain on exertion. There was a significant difference in recurrence rate, in favor of ACR-DCSS. Recovery was also significantly better for the ACR-DCSS group in terms of extension, supination and pain at rest. Arthroscopic treatment of wrist ganglion cyst is a reliable, minimally invasive and reproducible technique that produces good results in terms of pain and recovery of range of motion, with significantly lower recurrence rate in case of DCSS repair.Level of evidence: Therapeutic III.

Clinical outcomes of resecting scarpa's ganglion during vestibular schwannoma surgery

Vestibular schwannomas are slow-growing tumors arising from the Schwann cells of the vestibular nerve. Scarpa’s ganglion, the vestibular nerve ganglion, is located within the internal auditory meatus. Surgical treatment of vestibular schwannomas carries the potential of resecting Scarpa’s ganglion along with the tumor. No prior studies have evaluated outcomes based on the presence of Scarpa’s ganglion within tumor specimens. The neurosurgery patient records were queried for patients who underwent surgical resection of vestibular schwannomas at the University of Missouri Healthcare between January 1, 2008 and December 31, 2018. Inclusion criteria consisted of minimum age of 18, imaging demonstrating an eighth nerve tumor, surgical resection thereof, and a final pathological diagnosis of WHO grade I schwannoma. Data were collected retrospectively. The histological slides of the tumors were reviewed, and the presence or absence of the ganglion was noted. Outcomes analyzed included postoperative dizziness, hearing, and facial nerve function. Fifty-two patients met inclusion criteria. Ten (19%) resected tumors contained portions of the ganglion. No difference in risk of resection of ganglion occurred based on the surgical approach (p = 0.2454). Mean follow-up duration was 24.6 months ± 26.2 standard deviation. No differences in postoperative hearing or dizziness (p = 0.8483 and p = 0.3190 respectively) were present if Scarpa’s ganglion was resected. House-Brackmann classification of facial nerve function at last follow-up was similar (p = 0.9190). Resection of Scarpa’s ganglion with vestibular schwannomas does not increase risk of post-operative dizziness, facial nerve weakness, or hearing loss.

Outcomes of basal ganglia and thalamic cavernous malformation surgery: A meta-analysis

Surgical resection of basal ganglia (BG) and thalamic cavernous malformations (CMs) has not yet become standardized in the field of neurosurgery due to the eloquent location of these lesions and the relative paucity of literature on the subject. This review presents a consolidation of the available literature on outcomes and complication rates after surgical resection of these lesions. A systematic literature review was performed via PubMed database for articles published between 1985 and 2019. Studies comprising ≥2 patients receiving surgery for BG or thalamic CMs with available follow-up data were included. Pooled data included patient demographics, CM preoperative characteristics, and surgical outcomes Twenty studies comprising 227 patients were included for analysis. Complete resection was achieved in 94.7% (fixed-effects pooled estimate [FE]: 94.9%[91.0%–97.8%]; random-effects pooled estimate [RE]: 90.0%[79.8%–96.9%]), and hemorrhage of incompletely resected CMs occurred in 50% (FE: 55.9%[25.9%–83.6%]; RE: 55.9%[25.9%–83.6%]) of patients. Early morbidity was observed in 24.0% (FE: 24.9%[17.8%–32.6%]; RE: 24.9%[17.8%–32.6%]). At final follow-up, 67.3% (FE: 67.7%[58.8%–76.0%]; RE: 67.8%[52.2%–81.6%]) and 20.6% (FE: 20.6%[13.6%–28.6%]; RE: 20.9%[9.8%–34.9%]) had improvement and stability of preoperative symptoms, respectively. Mortality rate was 1.3% (FE: 2.3%[0.6%–5.1%]; RE: 2.3%[0.6%–5.1%]). Therefore, high cure rates with low rates of postoperative morbidity can be achieved in BG or thalamic CM surgery. Most patients had improved neurological function at final follow-up. Complete resection should be attempted to reduce rates of repeat hemorrhage.

Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis

ObjectiveThe objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilateral RLS in both sexes are also described in this study. MethodsThis is a longitudinal study of consecutive patients who sought specific treatment from a private practitioner for severe PPH as classified on the Hyperhidrosis Disease Severity Scale (HDSS) from October 2005 to October 2014. The patients were asked to report the symptoms of PPH experienced in the immediate preoperative period and to complete a standardized QoL questionnaire developed by de Campos at least 12 months after RLS. Disease outcomes, recurrence of symptoms, and any adverse effects of surgery were evaluated after 30 days and at least 12 months after RLS. ResultsLumbar sympathectomy was performed 116 times in 58 patients; 30 days after surgery, PPH was resolved in all patients. Three patients (5.2%) reported transient thigh neuralgia, and 19 (32.7%) reported transient paresthesia in the lower limbs. There were no reports of retrograde ejaculation. At a minimum of 12 months after RLS, 49 of the 58 patients had fully and correctly answered the follow-up questionnaire and noted a mild (HDSS 2) to moderate (HDSS 3) increase in pre-existing compensatory sweating. One patient had a PPH relapse within 6 months. Improvement in QoL due to the resolution of PPH was reported in 98% of the 49 patients. None of the operations necessitated a change in the laparotomy approach, and none of the patients died. ConclusionsRLS is safe and effective for the treatment of severe PPH in both sexes. There were no reports of retrograde ejaculation after resection of L3 and L4 ganglia. There was a mild to moderate increase in compensatory sweating in about half of the patients, but without any regret or dissatisfaction for having undergone the surgery because of a significant improvement in QoL.

Endoscopic Ganglionectomy of the Volar Radial Wrist Ganglion

Volar ganglion cyst of the wrist is a common hand problem faced by orthopaedic surgeons. Excision is indicated if it is painful. Arthroscopic ganglionectomy of the wrist ganglion has been reported with the advantage of minimally invasive surgery. Most of them involve elimination of the valvular mechanism and internal drainage of the ganglion fluid to the wrist joint. The access of the ganglion sac is limited especially for a multiloculated cyst. The purpose of this Technical Note is to report the technique of endoscopic resection of the volar radial wrist ganglion. This can ensure complete resection of the ganglion sac especially for the multiloculated one.

Endoscopic Resection of the Tarsal Tunnel Ganglion

The tarsal tunnel ganglion is a cause of posterior tarsal tunnel syndrome. Open resection of the ganglion calls for release of the flexor retinaculum and dissection around the tibial neurovascular bundle. This can induce fibrosis around the tibial nerve. We report the technique of endoscopic resection of the tarsal tunnel ganglion. It is indicated for tarsal tunnel ganglia arising from the adjacent joints or tendon sheaths and compressing the tibial nerve from its deep side. It is contraindicated if there is other pathology of the tarsal tunnel that demands open surgery; if the ganglion compresses the tibial nerve from its superficial side, which calls for a different endoscopic approach using the ganglion portal; or if an intraneural ganglion of the tibial nerve is present. The purpose of this technical note is to describe a minimally invasive approach for endoscopic resection of the tarsal tunnel ganglion.

Arthroscopic resection of wrist ganglia

The purpose of this study is to analyse the rate of recurrences of the dorsal ganglion resected by trans-cystic arthroscopic technique. All patients were operated on by a single surgeon with a minimum follow-up of 2 years.

Arthroscopic Resection of Wrist Ganglion Arising from the Lunotriquetral Joint

The dorsal wrist ganglion is the most common wrist mass, and previous studies have shown that it arises from the scapholunate interval in the vast majority of cases. Treatment has traditionally been open excision, and more recently arthroscopic resection has been established as an effective and less invasive treatment method. However, application of this technique to ganglia in atypical locations has not been reported, where open excision is the usual practice. This report describes two cases of atypical dorsal wrist ganglia that arose from the lunotriquetral (LT) joint, demonstrated by arthroscopic visualization and wrist arthrogram in one of them. Arthroscopic resection was performed, and the application of this technique to a dorsal wrist ganglion with an atypical origin and location is described.

Invited Commentary

Hundreds of articles have been published on primary hyperhidrosis, which affects approximately 3% of the general population, and despite decades of research we have no good pathophysiologic explanation for this disorder. We know that the sweat glands of patients with primary hyperhidrosis are normal in number and size but that hyperhidrotic patients have an abnormal sympathetic skin response. Few realize that the symptoms of primary hyperhidrosis, which may seem trivial to the general public, can cause so much social embarrassment in some patients that quality of life is reduced to a score comparable with that of end-stage renal disease, rheumatoid arthritis, or multiple sclerosis [1Cina C.S. Clase C.M. The Illness Intrusiveness Rating Scale: a measure of severity in individuals with hyperhidrosis.Qual Life Res. 1999; 8: 693-698Crossref PubMed Scopus (82) Google Scholar]. There are many surgical and nonsurgical ways to treat patients with primary hyperhidrosis and it is generally accepted that a sympathetic operation provides the only permanent treatment option. In the present study, de Moura Júnior and coauthors [2de Moura Júnior N.B. das-Neves-Pereira J.C. de Oliveira F.R.G. et al.Expression of acetylcholine and its receptor in human sympathetic ganglia in primary hyperhidrosis.Ann Thorac Surg. 2013; 95: 465-471Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar] used immunohistochemistry to evaluate the sympathetic ganglia from patients with palmar hyperhidrosis and used brain-dead organ donors with no history of hyperhidrosis as control individuals. They quantified the expression of primary antibodies against receptor subunits as well as acetylcholine, which is the primary neurotransmitter in sympathetic ganglia, and they found a significant difference between the two groups. The reason for this difference is speculative, but could it suggest that increased acetylcholine expression in the ganglia of patients may be related to hyperactivity of the central portion of the sympathetic nervous system, or that the sympathetic ganglia are able to modulate the nervous stimuli from the central nervous system and play a role in the pathophysiology of primary hyperhidrosis. The authors also made a new observation that the diameter of thoracic sympathetic chain ganglia was larger in hyperhidrotic patients. There are obvious limitations with the present study, because the two groups differed with respect to age and sex, and this should be addressed in future studies. Nevertheless, this article is a major contribution to our understanding of primary hyperhidrosis, providing a hint to its primary cause, and this is valuable information to thoracic surgeons and their patients. More importantly, this article points to where future research should be directed for complete elucidation and understanding of hyperhidrosis, which is such a frequent problem. Expression of Acetylcholine and Its Receptor in Human Sympathetic Ganglia in Primary HyperhidrosisThe Annals of Thoracic SurgeryVol. 95Issue 2PreviewThe pathophysiologic characteristics of primary hyperhidrosis are not well understood and seem to be related to a sympathetic nervous system dysfunction. The resection of thoracic sympathetic chain ganglia is the most effective treatment for hyperhidrosis; however sympathetic ganglia function in normal individuals and in patients with hyperhidrosis is unknown. Full-Text PDF

Expression of Acetylcholine and Its Receptor in Human Sympathetic Ganglia in Primary Hyperhidrosis

The pathophysiologic characteristics of primary hyperhidrosis are not well understood and seem to be related to a sympathetic nervous system dysfunction. The resection of thoracic sympathetic chain ganglia is the most effective treatment for hyperhidrosis; however sympathetic ganglia function in normal individuals and in patients with hyperhidrosis is unknown. A cross-sectional study, in which 2 groups of 20 subjects were analyzed: the hyperhidrosis group (HYP), comprised of patients with hyperhidrosis who were eligible for thoracic sympathectomy, and the control group (CON) comprised of brain-dead organ donors without a history of hyperhidrosis. For each subject, the following were performed: resection of the third left sympathetic ganglion, measurement of the ganglion's diameter, and immunohistochemical evaluation by quantification of strong and weak expression areas of primary antibodies against acetylcholine and alpha-7 neuronal nicotinic receptor subunit. The presence of a strong alpha-7 subunit expression area was 4.85% in patients with primary hyperhidrosis and 2.34% in controls (p < 0.001), whereas the presence of a weak expression area was 11.48% in the HYP group and 4.59% in the CON group (p < 0.001). Strong acetylcholine expression was found in 4.95% of the total area in the HYP group and in 1.19% in the CON group (p < 0.001), whereas weak expression was found in 18.55% and 6.77% of the HYP and CON groups, respectively (p < 0.001). Furthermore, diameter of the ganglia was 0.71 cm in the HYP group and 0.53 cm in the CON group (p < 0.001). There is a higher expression of acetylcholine and alpha-7 neuronal nicotinic receptor subunit in the sympathetic ganglia of patients with hyperhidrosis. Furthermore, the diameter of the thoracic sympathetic chain ganglia is larger in such patients.

Electroacupuncture upregulated platelet derived growth factor expression in spared dorsal root ganglion of cats.

A bilateral spared dorsal root ganglion model was established in healthy adult cats by bilateral resection of L1-5 and L7–S2 dorsal root ganglia. L6 dorsal root ganglia were spared. Zusanli (ST36) and Xuanzhong (BL39) or Futu (ST32) and Sanyinjiao (SP6) were alternatively electro-stimulated on the right leg. Immunohistochemical staining of anti-serum platelet-derived growth factor demonstrated that the number of total neurons and medium-small sized platelet-derived growth factor positive neurons was significantly decreased on the 7th day following injury. After 7 days of acupuncture, the total number of positive and large neurons staining for platelet-derived growth factor on the acupuncture side significantly increased compared to the non-acupuncture side. After acupuncture for 14 days, the total positive and medium-small sized neurons significantly increased compared with the non-acupuncture side. Results indicate that acupuncture promoted the synthesis of platelet-derived growth factor in spared dorsal root ganglia.

Extrahepatic Bile Duct Cancer: Invasion of the Posterior Hepatic Plexuses—Evaluation Using Multidetector CT

To assess the utility of axial and coronal reformatted multidetector computed tomographic (CT) images in the evaluation of the invasion of posterior hepatic plexuses by extrahepatic bile duct cancer. This retrospective study was approved by the institutional review board, and informed consent was waived. Forty-three patients (22 men, 21 women; age range, 40-80 years; mean age, 65 years) with surgically resected cancer involving the extrahepatic bile duct between December 2004 and September 2010 were included. Posterior hepatic plexus 1 runs from the superior and middle bile duct to the right celiac ganglion, and posterior hepatic plexus 2 runs between the lower bile duct and right celiac ganglion behind the portal vein. Invasion of the posterior hepatic plexuses was elucidated by using pathologic and postoperative multidetector CT findings. Three radiologists independently evaluated the preoperative axial and coronal reformatted images with a separate viewing session for the invasion of posterior hepatic plexuses that was detected on the basis of the presence of increased attenuation of fat tissue along the nerve routes. Receiver operating characteristic analysis was performed to compare the diagnostic performance of the two image interpretations. Invasion of posterior hepatic plexus 1 and of posterior hepatic plexus 2 was recognized in 10 (23%) and nine (21%) of 43 patients, respectively. The diagnostic performance of coronal reformatted image interpretation was significantly greater than that for axial image interpretation (mean area under the curve, 0.99 vs 0.89, P = .04; mean accuracy, 95% vs 82%, P = .003). In all reviewers, one false-positive diagnosis of the invasion of posterior hepatic plexus occurred on axial and/or coronal image display types because of fibrosis and inflammatory cell infiltration along these plexus routes. Coronal reformatted images can be useful for accurate diagnosis of the invasion of posterior hepatic plexuses and may facilitate surgical decision making in regard to the resection of celiac ganglion.

Thoracoscopic Sympathectomy for Primary Palmar Hyperhidrosis: Resection Versus Transection—A Prospective Trial

Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia versus transection of the chain over the second to fourth ribs. During the period September 2000 to June 2002, a total of 32 patients with IPHH were operated on. Operations were performed under general anesthesia through two 5-mm trocars using electrocautery. Resection was done on one side and transection on the other, with both sides being addressed during the same operation. The sides of resection/transection were alternated at each operation. There were 14 men and 18 women aged 18.8 +/- 4.7 years. The mean operating times for sympathectomy were 12.0 +/- 3.1 minutes for resection and 6.6 +/- 1.9 minutes for transection (p = 1.38). All patients were examined at 2 weeks postoperatively and again at 1 month. During November-December 2005, patients were approached by telephone questionnaire, the mean follow-up period being 4.3 +/- 0.9 years. Altogether, 26 of the 32 patients could be located (15 women, 11 men). There was no significant difference with regards to perioperative complications, immediate or long-term pain. All but two hands were warm and dry 1 month after operation and remained so at follow-up. The exceptions included one hand with recurrent hyperhidrosis after 1.5 years and one that became less dry and cold at 3 years. Both were on the transected sides. Our results suggest that sympathetic resection may achieve slightly better long-term results than transection in patients with IPHH. Large-scale prospective studies are needed to confirm these results.

Intérêt thérapeutique de l'arthroscopie du poignet : à propos de 1000 cas

Wrist arthroscopy is a relatively recent procedure because it was described in the 70's. During the first period of 80's it became an indisputable technique of diagnosis. Since the 90's many therapeutic procedure were described by several authors all over the world. This technique increase a lot the understanding of wrist pathologies and ameliorate significantly the results for patients. We report our experience about 1000 wrist arthroscopy between 1998 and 2005. The patients were always operated on outpatient basis under local regional anaesthesiology. The arm was laid on the table and the hand on in-line traction (5-7 kg). We used a 2.4 mm arthroscope, 30 degrees angled. The both joints, radiocarpal and midcarpal, were systematically explored. The small portals were not closed. In our experience, only 42 arthroscopies (4%) were without surgical procedure. We separated the indications in 7 chapters: 1) arthoscopic assistance for fractures treatment (distal radius and scaphoid: 7%; 2) TFCC tears (17%); 3) treatment of intrinsic ligaments tears (scapholunate and lunotriquetral: 21%); 4) ectomy (radial styloidectomy, wafer, carpal boss 13%); 5) resection of wrist ganglia (21%); 6) partial prosthesis (2,5%); 7) others techniques (arthrolysis, synovectomy 14,5%).

History of sympathetic surgery.

The first reported operation on the upper sympathetic system was performed by Alexander in 1889. The initial indications (epilepsy, exophthalmic goiter, idiocy, glaucoma) are obsolete. For some subsequent indications (angina pectoris, vasospastic disorders, and painful conditions) sympathectomy has still a limited application. The main indications today are hyperhidrosis (since 1920) and blushing. Renewed attempts to perform the operation for psychological conditions have been reported. The technique of sympathectomy has been modified over the century, with a trend to minimize the extent of surgery: from open to endoscopic approaches; from resection of ganglia to thermoablation, thermotransection, and clipping. The sequelae of the operation (mainly compensatory hyperhidrosis) present a major problem in a small percentage of operated patients. Techniques of reversal (by nerve grafting and unclipping) have been proposed. Meticulous follow-up studies are required to evaluate the merits of these techniques. Improved knowledge of the functions and interrelations of the autonomic nervous system is required to understand the mechanism of these sequelae and learn how to avoid or treat them.

Arthroscopic resection of volar ganglion of the wrist: A new technique

We evaluated a new arthroscopic technique for treating volar ganglion of the wrist. Arthroscopic resection of volar wrist ganglion was performed under local anesthesia to the portal sites. Arthroscopic instruments were introduced dorsally, and the intra-articular lesion at the interval between the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments was debrided under direct view. Mucinous content of the ganglion was evacuated using suction, but the ganglion sac was not removed. The technique was successful in 5 cases between August 1997 and November 1998, with an average surgery time of 55 minutes. No complications or recurrence occurred at a mean follow-up of 16.4 months. This is the first report of arthroscopic decompression of volar wrist ganglions and provides new insight into the etiology of these lesions.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 218–221

Arthroscopic resection of wrist ganglia

Arthroscopic resection of wrist ganglia