Ganglion cysts and nerves

Ganglion cysts are benign, contained collections of mucin, typically related to neighboring synovial joints that may affect nerve indirectly by extrinsic compression or directly by intrinsic compression. A unifying synovial (articular) theory explains extraneural and intraneural ganglia in terms of their dissection through capsular defects separate from or within articular branch connections. Depending on the site of the capsular defect, these cysts tend to form along paths of least resistance and take shape by pressure fluxes. Identification of the non-neural or neural joint connection ("pedicle" ) and its surgical removal is important to decrease recurrence and to improve patient outcomes. New imaging techniques can help the radiologist and treating surgeon detect the pedicle, obtain a preoperative diagnosis and direct the nature of the intervention. This review summarizes recent advances in the pathogenesis, evaluation, and management of patients with ganglia affecting nerve.