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Temporomandibular joint (TMJ) synovial cysts are rare, unlike peripheric locations like the wrist or the knee. They share similar presentations with ganglion cyst, benign and sometimes malignant lesions. Only histopathological analysis confirms diagnosis in some cases, finding a true cyst lined by synoviocytes containing synovial fluid. They seem to be related to an increased articular pressure following trauma. In this study we present two cases of TMJ synovial cyst and a systematic review of the literature. A total of 32 cases were retrieved from published literature in PubMed, Cochrane Library and ClinicalTrials.gov databases using the search terms ‘TMJ synovial cyst’, ‘temporomandibular synovial cyst’, ‘jaw joint synovial cyst’. Swelling (91.3%) and pain (78.3%) were the most common symptoms. MRI was the most commonly used imaging modality that was found to be beneficial for diagnosis. In almost all cases the cyst was removed under general anesthesia, allowing histopathological examination. Only two patients still had pain after removal of the cyst. No recurrence was observed .

Facet joints are the important articular pillars of the spine. Several pathologies can occur in and around the facet joint, including extra ossicles, traumatic dislocation, osteoarthritis, synovial cyst, axial spondyloarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, septic arthritis, and malignant and benign neoplasms. Imaging is the mainstay to detect and characterize these diseases. In this review, we discuss the anatomy and function of facet joints, imaging techniques, and the imaging findings of several facet joint diseases. This information may be helpful to radiologists to make the correct diagnosis and optimize the management of patients with facet joint diseases.

Introduction. Synovial cyst or hygroma is a common disease that occurs in both children and adults, but it is most often observed in people 20–45 years old. More than 60% of patients who go to the polyclinic with complaints about the presence of tumor-like formations have hygroma.Goal. Analysis of the results of treatment of synovial cysts of the hand and wrist joint according to our own observations and literature data.Material and methods. We observed 54 patients suffering from hygroma of the hand and wrist joint, who were treated in polyclinic No. 2 and MEDEL multidisciplinary clinic in Kazan from 2005 to 2020. The treatment of hygrom was carried out using conservative (puncture) and surgical methods. Results. Our experience showed that after a single puncture of the hygroma with the evacuation of its contents (10 patients), relapse developed in all cases. After repeated puncture of the hygroma in 10 patients with evacuation of the contents and subsequent administration of 0.5 ml of betaspan solution, 6 of them did not relapse within 5–6 months, but 4 patients had a relapse in the nearest period (1–2 months). Of the 23 patients who underwent surgery to remove the hygroma, 15 of them had no relapses. In 8 patients in the postoperative period, recurrent hygroma occurred, which could be explained by the ineffectiveness of eliminating the communication zone between the hygroma and the joint.Conclusions. For the successful treatment of this disease, it is important to understand that for the occurrence and development of hygroma, its communication with the joint cavity or tendon vagina is of great importance. In the absence of a message, the successful use of puncture methods of treatment is possible. In the presence of such a message and its detection during preoperative examination, surgical treatment should be planned with mandatory ligation of the leg of the hygroma.

A 67-year-old woman had a painless tumor in the pulp of her left little finger, which was diagnosed as a synovial cyst. She underwent 2 surgeries to remove the cyst; however, she had a third recurrence. Magnetic resonance imaging revealed that the cyst originated from the flexor tenosynovitis associated with degenerative arthritis of the distal radioulnar joint and pisotriquetral joint. We performed flexor tenosynovectomy and a salvage procedure for the degenerative wrist joint with a Sauve-Kapandji procedure for distal radioulnar joint osteoarthritis and pisiformectomy for pisotriquetral joint arthritis. One year after surgery, the synovial cyst had not recurred, and the functional outcomes of the wrist joint were good. Flexor tenosynovectomy and concurrent joint salvage procedure may be good treatment choices for synovial cysts originating from the flexor tenosynovitis associated with a degenerative wrist joint.

We report the case of a 61-year-old man who had presented with acute unilateral limb swelling. Computed tomography venography and duplex ultrasound demonstrated compression of the right common femoral vein by a common femoral vein adventitial cyst. Before intervention, the patient had developed an acute deep vein thrombosis of the right common femoral vein and great saphenous vein. Preoperative magnetic resonance imaging demonstrated concern for synovial connection. After 6 months of anticoagulation therapy, the patient underwent adventitial cyst excision with ligation of the hip joint articular connection. At 4 months postoperatively, the patient was symptom free without cyst recurrence. The findings from the present case support the synovial theory for adventitial cystic disease.

Background Cystic adventitial disease is a rare, nonatherosclerotic disease that affects various arteries and veins, involving the formation of a mucinous cyst within the adventitia. The etiology of the cystic adventitial disease is currently unclear, with several hypotheses having been suggested. The purpose of this retrospective observational study was to evaluate the etiology of popliteal cystic adventitial disease based on imaging and surgical findings and to evaluate the efficacy of surgical treatment. Methods From April 2013 to January 2020, nine patients were diagnosed with the popliteal cystic adventitial disease and underwent surgical treatment. We performed complete resection of the cyst and the affected segment of the popliteal artery, followed by interposition with autologous reversed small saphenous vein or great saphenous vein. Results The resected adventitial cyst tissue was multilobular, filled with high-viscosity mucus. Pathologic examination of the surgical specimen revealed intramural cysts filled with gelatinous material located between the media and the adventitia, consistent with the clinical diagnosis of cystic adventitial disease. The median follow-up period was 27.5 months (range: 2–91 months). All patients underwent cyst excision with graft interposition, and the overall graft patency was 80.9 months (95% CI: 62.2–99.6 months). Conclusions Computed tomography, magnetic resonance imaging, and surgical findings confirmed communication between the synovial cyst and arterial adventitia. It is recommended that priority be given to surgical resection and graft interposition because this can eliminate the disease’s cause and reduce its recurrence.

Lumbosacral radiculopathy is very common presentation in old age people. Of the more common causes, the rarest is the presence of Lumbar intrasynovial cysts (LISCs). This case report of a 64 year old patient presenting with low back pain radiating to left leg and presence of a LISC (MRI finding) at L4-L5 has set a very good example for considering FGPCR for treatment. The patient reported 90% relief in pain after the procedure. So FGPCR can be considered before proceeding for surgery.

To describe a unique presentation of fever and bilateral bicipital synovial cysts in young female with systemic juvenile idiopathic arthritis (SJIA). A previous healthy 5-year-old female presented ...

Background: Synovial cysts of the hip are commonly found in patients with intra- or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases, this was feasible by hip arthroscopy, as a minimally invasive and safe technique.

Synovial cysts are the most common condition in hand surgeon practice. Open surgical resection was a traditional method of treatment but it is associated with numerous complications. We describe our first patient follow up after arthroscopic wrist ganglion resection.

Summary of background data Despite a good understanding of the natural history of spinal synovial cysts (SCs), a widespread agreement regarding their optimal management is still lacking. This is particularly true for SCs occurring at the C1-C2 level, which are rare, but oftentimes lead to a rapidly evolving cervical myelopathy. Methods We report a series of 4 patients (M:F ratio = 1:1; mean age 63.5 years) presenting with progressive cervical myelopathy secondary to ventrally located C1-C2 SCs. All patients underwent a postero-lateral facet-sparing intradural approach with total excision of the SCs. Functional status was assessed pre- and postoperatively with Nurick scale and the modified Japanese Orthopaedic association grading. Furthermore we conducted a systematic review, following PRISMA guidelines of pertinent literature to contextualize the options for surgical management of such lesions. Results Complete excision of the SCs was confirmed radiologically and on histological analysis. All measures of functional status improved post-operatively, and no cyst recurrence or need for instrumented fusion were noted during follow up (range from 22 to 88 months). Conclusion Our experience suggests that the facet-sparing intradural approach provides excellent clinical outcomes without causing any C1–C2 instability. This is in keeping with the take home message emerging from our literature review, which confirms that treatment should aim at radical resection of SCs while minimizing the risk of postoperative instability.

Background There is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature. Methods Retrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score. Results Sixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4–L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level. Conclusion In symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.

Highlights • Chronic inflammation of the synovial cyst induces neovascularization of its wall leading to a possible intra-cystic bleeding. • The different signal modulations on MRI are due to the variable consistency and density of the cystic fluid. • Synovial cyst hemorrhage produces a sudden increase in the size of the lesion with compression of the spinal cord and nerve roots. • Surgery is the appropriate treatment in case of synovial cyst with spinal cord compression., Introduction Cervical synovial cysts are uncommon. They are most often responsible for a chronic clinical picture. Rarely, intracystic hemorrhage occurs, and may acutely present as radicular – or even spinal cord compression syndrome leading to irreversible neurological impairment. Case We reported a case of bleeding synovial cyst located in the cervico-thoracic spine causing spastic paraparesis in a 68-year-old male patient. MRI revealed narrowing of perimedullary subarachnoid space by a well circumscribed, extra-axial, homogeneous mass located posterolaterally to the right of the spinal cord at the level C7-T1. The cyst was removed thoroughly by laminectomy. Pathological findings were consistent with the diagnosis of hemorrhagic synovial cyst. The patient had an excellent recovery. Discussion Synovial cysts of the spine are rare and usually asymptomatic. It is extremely rare for intracystic bleeding to occur and be responsible for an abrupt presentation. Diagnosis of spinal synovial cyst relies on MRI but may not be evident as it depends on consistency and density of the cystic fluid. Surgery remains the best therapeutic alternative, especially in the case of neurological impairment. Conclusion Surgery should be considered for any cervical synovial cyst. This is motivated by the risk, although rare, of bleeding and the resulting irreversible neurological damage that may occur.

BACKGROUND Lumbar juxtafacet cysts are benign lesions that grow at the level of facet joints or within neighboring structures. Recently, there is an ongoing trend toward less invasive procedures for treating degenerative spine diseases. Here we report a multicenter study of full-endoscopic surgery for juxtafacet cyst removal. METHODS We prospectively collected patients with a diagnosis of lumbar juxtafacet cyst surgically treated in 3 institutions between January 2017 and August 2019. Patients of any sex and age were eligible if they had a single level unilateral lumbar juxtafacet cyst, invalidating radicular pain lasting >6 weeks, adequate imaging, and failed percutaneous or conservative treatment. Age at diagnosis; sex; preoperative, postoperative, and 6-month leg pain; surgical and medical complications; spine instability (preoperatively and at 6 and 12 months); and follow-up time were collected. RESULTS Thirty-five patients were enrolled. Median operative time was 78 minutes, and mean leg pain went from a preoperative value of 6.8 (standard deviation [SD] = 1.2) to a postoperative value of 3.4 (SD = 1.1, P

Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.

This report describes the clinical and pathologic characteristics of cystic and myxomatous lesions of synovial joints in 16 cats. The average age was 13.4 years. The elbow was most commonly affected (12/16), and all lesions were unilateral. Degenerative joint disease was a frequent concurrent but bilateral condition. The lesions consisted of fluid-filled cysts lined by synoviocytes (3 cases), solid foci of stellate cells in a myxomatous matrix (2 cases), or a combination of the two (11 cases). In some cases there were areas of transition between the cystic and myxomatous lesions. Mitoses and other features of malignancy were rare to nonexistent. In the 13 cats with follow-up information, the lesion gradually increased in size over a period of years. None of the cats died or were euthanized because of this lesion. We propose that some cats with degenerative joint disease develop synovial cysts, which have the potential to transform to a synovial myxoma.

Study design Case report. Objective To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst. Summary of background data Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1-C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression. Methods A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst. Result The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity. Conclusion A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression. Level of evidence 5.

Occipital neuralgia typically arises in the setting of nerve compression by fibrosis, surrounding anatomic structures, or osseous pathology, such as bone spurs or hypertrophic atlanto-epistropic ligament. It generally presents as paroxysmal bouts of sharp pain in the sensory distribution of the first three occipital nerves. Due to the long course of the greater occipital nerve (GON), and its peculiar anatomy, and location in a mobile region of the neck, it is unsurprising that the GON is at high risk for compression. Little is known how to diagnose or treat this neuropathic pain syndrome. The objective of this paper is to isolate the etiology involved, and treat this condition promptly. After all nonoperative efforts are exhausted, surgical transection of the nerve is the treatment of choice in these cases. An isolated C2 neurectomy or ganglionectomy is performed for an optimal pain relief. C1-2 instrumented fusion can be considered if, extensive facet arthropathy with instability is identified. Authors review the spectrum of treatment options for this debilitating condition, and discuss the case example of a patient who required conversion to a C1-C2 instrumented fusion following C2 ganglionectomy due to an underlying extensive degenerative disease and intraoperative findings suggestive of atlantoaxial instability.

Introduction Acromioclavicular joint cyst (AJC) is a very uncommon condition of the shoulder observed in elderly patients, caused by a degenerative acromioclavicular (AC) joint, frequently associated to a rotator cuff tendon tear. There are two possible cause for the cyst formation. We report two different cases of a AC synovial cyst, with and without rotator cuff tear. Presentation of cases We report two cases, in patients aged respectively 80 and 77 years, with a very large AJC. In one case, the cyst was associated to a rotator cuff tear, while in the other case, the rotator cuff did not present any evident lesion. Both cysts were successfully surgical excised and a distal clavicle resection was performed. Discussion AJC is a rare complication observed in degenerative AC joint and in the majority of cases is associated to a rotator cuff tear. The diagnosis may be made by ultrasound and conventional radiographic examination, although MRI of the shoulder is generally preferred as it allows to better identify the condition of the rotator cuff. Generally, local aspiration of the cyst and corticosteroid injection fails with recurrence of the cyst and surgically treatment is indicated, especially in painful cases. Conclusion Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.

Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.

Background Synovial cysts are cystic masses lined with pseudostratified columnar cells and containing clear or xanthochromic fluid. Although they are commonly encountered in the lumbar spine, synovial cysts infrequently occur in the cervical spine and rarely involve the odontoid process. The causes of synovial cysts of the odontoid process are unknown, but growth of synovial rests, proliferation of multipotent mesenchymal cells, atlantoaxial instability, and trauma are thought to play a role. Case Description We present 3 cases of atlantoaxial cysts with the associated radiographic features, surgical management, and clinical outcomes. No patient had rheumatoid arthritis. In all cases, preoperative differential diagnosis included neoplastic pathologic changes. Two patients underwent odontoidectomy through either an endonasal or a transoral approach, followed by posterior occipitocervical fusion. The third patient underwent an endoscopic transsphenoidal approach for cyst decompression. Conclusions Tissue diagnosis is important in confirming pathologic analysis because synovial cysts have radiographic characteristics similar to those of a wide variety of neoplasms of the craniovertebral junction.

Lumbar synovial cysts (LSC) can impinge neural structures, causing radicular back pain. Conservative treatment options; however, are often ineffective, and traditional surgical techniques can cause joint instability. We describe two cases in which interventional pain physicians used transforaminal endoscopic spine surgery to treat LSC. The patients reported complete resolution of their lower back and radicular pain and the procedures preserved their motor function and sensation in their bilateral lower extremities. This technique is a viable option for remediation of LSC and can be performed by well-trained pain physicians.

Background The presence of symptomatic lumbar facet cysts has been associated with segmental instability. Given this association, decompression versus decompression with fusion is a frequently debated topic. Multiple grading scales have been devised to identify patients at high risk for development of cyst recurrence; however, there exists no external evaluation of these scales. Methods A retrospective review of 54 patients undergoing initial treatment for lumbar synovial cysts at a single institution over the past 12 years was conducted. Surgical treatment consisted of decompression with cystectomy without fusion. Patients were assessed and classified according to the NeuroSpine Surgery Research Group (NSURG) and Rosenstock Classification systems. Five neurosurgeons reviewed the preoperative magnetic resonance images, and results were classified. Interrater reliability was assessed using both Gwet’s AC1 coefficient and Krippendorff’s alpha. A 1-way analysis of variance was used to evaluate predictive ability of both classification systems. Results In total, of the 54 patients who underwent decompression, 7 had cyst recurrence. Overall cyst recurrence was most common in NSURG grade 2 cysts (3/12, 25%) followed by grade 1 cysts (4/27, 14.8%). Of the NSURG grade 3 and 4 patients, none had cyst recurrence. In the Rosenstock grades the most common recurrence was in grade 3 cysts (1/4, 25%) followed by grade 1 cysts (5/26, 19.2%). Interrater reliability demonstrated good reproducibility on Gwet’s AC1 and Krippendorff’s alpha on both grading scales. Neither score was predictive of cyst recurrence (P > 0.05). Conclusions The Rosenstock and NeuroSpine scores demonstrate good overall interrater reliability but are inconsistent in their ability to predict recurrence of lumbar facet cysts.

Cistos sinoviais são lesões extradurais benignas caracterizadas por um revestimento de epitélio sinovial que contêm líquido claro ou xantocrômico. Apresentam-se como herniação da cápsula articular da faceta intervertebral degenerativa. Podem desenvolver-se a partir de qualquer articulação revestida por membrana sinovial ou bainha tendinea, sendo relativamente incomuns na coluna vertebral e raros na topografia cervical. Objetivo: Descrever um caso de cisto sinovial cervical em paciente com sustentada radiculopatia dolorosa e discutir sobre a abordagem cirúrgica nestes casos. Métodos: Baseou-se em coleta de dados do prontuário da paciente e revisão de literatura nas bases de dados da Biblioteca Virtual de Saúde (BVS). Resultados: Obteve-se, através da abordagem cirúrgica com realização de hemilaminectomia de C6 à esquerda, a exérese do cisto, contribuindo para melhora da qualidade de vida da paciente, que evoluiu assintomática no pós-operatório. Conclusão: A maioria dos casos relatados de cistos sinoviais cervicais ocorreram no nível C7/T1. Assim, a formação dessa entidade ao nível de C6/C7 deve ser considerada como distinta, particularmente em pacientes com suspeita de hérnia de disco intervertebral. Visualiza-se assim, que devido à persistência dos sintomas na paciente, a ressecção cirúrgica mostrou-se eficaz e com bom resultado pós-operatório, sendo, também, uma boa alternativa.

Spinal synovial cysts are relatively uncommon and are most frequently found in the lumbar spine and rarely in the cervical spine. Intraspinal extradural cervical synovial cysts can occur and potentially cause cord/nerve root compression with symptoms of myelopathy/radiculopathy; however, most are asymptomatic and incidental findings. We conducted a literature review and present, to our knowledge, the largest imaging case series and describe the magnetic resonance imaging features of cervical synovial cysts.

Background Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints. Case presentation We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1–2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5–6 to S1-S2. The cysts between L5–6 and L7-S1 ranged from 0.12 to 0.44cm2 at their largest area. The largest cyst was located at S1–2 (left), measuring 0.84 cm2 at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1–2 had reduced in size. Mean reduction in size was 59.6% (35–81%). Conclusions In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.

Background Juxtafacet cyst (JFC) included both synovial and ganglion cysts adjacent to a spinal facet joint or arising from the ligamentum flavum of the spinal facet joints. Various treatments have been proposed; however, surgical approach appeared to be the most effective. Here, we reviewed patients with lumbar JFCs treated using full endoscopic approach in our hospital. We then elaborate the details of the surgical routes and techniques and their merits and pitfalls. Methods Eight patients who visited the neurosurgical department of Changhua Christian Hospital, Taiwan, and diagnosed with lumbar JFCs were included. All patients underwent complete endoscopic cyst removal. The outcomes we followed-up were muscle power, visual analog scale score(VAS), modified MacNab criteria score and MRI. Results A total of eight patients were enrolled in this study. Five patients received interlaminar approach, 2 patients received transforaminal approach, and 1 patient received transfacet approach. Their VAS had significantly reduced [range, 5–10 (mean 7.75) prior to surgery and 0–2 (mean 0.625) post-surgery], and the modified MacNab criteria score ranked from good to excellent post-surgery. No neurological injuries were observed. Conclusion JFCs could be effectively treated by full endoscopic technique. The type of approach should be based on the anatomical site of the lesion and the condition of the patient. Interlaminar approach is appropriate for cysts located in the lower segment with larger interlaminar space. The transforaminal or transfacet approach is preferred for patients with high risk of general anesthesia.

Background and importance: Synovial cysts of the cranio-cervical junction constitute an uncommon pathology in neurosurgical practice. Different surgical approaches have been described for treating those lesions including trans-oral microsurgical approaches, endoscopic endo-nasal approaches and sub-occipital trans-dural approaches. Objective: The purpose of this article is to describe a case of resection of a retro-odontoid synovial cyst through a modified far-lateral trans-atlas extradural approach. A detailed surgical plan with cadaveric dissection is presented as well as literature review of surgical approaches. Methods: The authors describe an 86-year-old man presenting with gradual deterioration of his gait as well as upper and lower extremities weakness. He was found to have an odontoid pannus accompanied by midline retro-odontoid cyst on MRI. An anatomical cadaveric dissection describing the modified far-lateral trans-atlas extradural approach is described and then used to completely resect the cystic lesion, decompress the brain stem and perform a fusion of the cranio-cervical junction. Result: This surgical technique allows for the decompression and fusion to be performed in the same operative time, avoids the contaminated surgical fields encountered during anterior approaches and prevents CSF leakage by avoiding dura opening. Conclusion: Modified Far-Lateral Transatlas Approach offers several advantages when compared with the other options and can provide an alternative to treat these patients. Keywords: Far-lateral approach, Odontoid pannus, Operative technique, Retro-odontoid cyst, Synovial cyst

Intraspinale lumbale Wirbelgelenkszysten stellen eine nicht alltagliche Ursache einer Nervenwurzelkompressionssymptomatik dar und unterscheiden sich klinisch nicht wesentlich von den Symptomen eines Bandscheibenvorfalls. Die Zysten haben ihren Ursprung an den kleinen Wirbelgelenken und uben je nach Grose eine Kompression auf nervale Strukturen aus. Die betroffenen Wirbelgelenke weisen bei allen Patienten arthrotische Veranderungen auf, welche in etwa 50 % der Falle mit einer degenerativen Spondylolisthese verbunden sind. Mittels MRT und CT ist in den allermeisten Fallen eine diagnostische Zuordnung moglich. Die exakte Atiologie ist bisher noch nicht vollstandig geklart. Verschiedene Faktoren, wie eine aktivierte Arthritis bei stark degenerativ veranderten Wirbelgelenken, scheinen eine wesentliche Ursache darzustellen. Die Therapieoptionen beinhalten die konservative, die semiinvasive und die operative Therapie. Konservative und semiinvasive Behandlungsmethoden fuhren zu temporarer Besserung. Das Ergebnis der operativen Therapie ist demgegenuber jedoch bei einer kompletten Resektion der Synovialzyste exzellent. Eine primare Fusion ist in seltenen Fallen notwendig.

Anterior, benign epidural cysts are a rarely described cause of non discal lumbar radiculopathy. The differentiation between synovial, ganglion, fibrous annulus, posterior longitudinal ligament and disc cysts reflects the fragmentary nature of reports so far and it's probably misleading. A case of ventral L5-S1 synovial cyst is reported and the literature is reviewed. It is proposed that these lesions be all grouped together as anterior epidural degenerative cysts of the lumbar spine on the ground of shared clinical and MRI features and management options along with a common pathogenesis (response to degenerative spinal changes) and histological substrate. Keywords: Lumbar spine, Epidural cyst, Pathology

Background Isolated hypoglossal nerve palsy caused by an atlantooccipital synovial cyst is a rare lesion, with fewer than 5 cases reported in the literature. Case Description Our patient presented with acute hypoglossal nerve dysfunction. Our differential included neoplasm, trauma, stroke, multiple sclerosis, or other inflammatory/infectious etiology. Imaging revealed a peripherally enhancing, extradural focus in the left premedullary cistern, most likely consistent with a synovial cyst. Conclusions A left suboccipital craniectomy was performed in the region of the left hypoglossal canal, in which a cystic structure was noted at the occipital condyle and C1 vertebral junction. The nerve was adequately decompressed via aspiration of the cyst. Postoperatively, the patient substantially improved. Although rare, synovial cysts must be included in the differential diagnosis of atlantooccipital lesions.

Ligamentous cyst is a cystic formation arising from degeneration of ligamentous structures all around the spinal cord. They can cause spinal cord compression, like synovial cyst. Unlike synovial cyst, there is no spinal instability in pathogenesis of ligamentous cyst. Differential diagnosis through pre-operative MRI is difficult and intraoperative findings plus histopathology are crucial to achieve a diagnosis. In this case report, we deal with a rare case of cervical junction ligamentous cyst. A 59-year-old Caucasian female was admitted in our ward with left-sided hemiparesis, cervical pain, and upper limb diffused paresthesias, due to an oval-shaped formation into ALL, of 13 mm in maximum diameter, with peripheral contrast enhancement. The patient underwent, under general anesthesia, a surgery through a posterolateral suboccipital approach which aimed to decompress the spinal cord and to drain the cyst with total removal of the compression by emptying the cyst and fulfilling it with muscle graft and glue. No posterior fixation was needed. After the surgery, symptoms improved and a post-operative MRI scan demonstrated the good result of the surgery.

Spinal synovial cysts are degenerative extradural lesions mostly found in the lumbar region, and more rarely at cervical or thoracic levels and in a bilateral presentation. We report a patient with a history of progressive paraparesis associated with bilateral cervicothoracic synovial cysts, causing spinal canal narrowing and cord compression, ultimately resulting in myelopathy. A review of the literature summarizes previous reports on this topic. Surgical excision of the extradural mass, decompression of the spinal canal and instrumented fusion were performed, improving lower limb deficit and gait. Post-surgical MRI showed evidence of complete cyst resection, and good arthrodesis consolidation with adequate sagittal balance. Surgical excision is indicated in case of medical treatment failure or increasing symptom severity. Given the strong pathophysiological link between synovial cysts and spinal instability, concomitant instrumented fusion may help improve outcome.

Although the nail is a small anatomical structure, it can be affected by various tumors and tumor-like conditions. Because of the distinctive nail anatomy, the clinical presentation of tumors is modified, thus rendering the diagnosis challenging. As nail biopsy and surgery are painful procedures associated with an increased risk of permanent onychodystrophy, pre-operative diagnosis is desirable. Although conventional radiographs are still the first-line radiologic examination for the assessment of bony structures beneath the nail matrix, they do not allow detailed evaluation of the phalangeal soft tissues. High resolution MRI allows accurate detection and mapping of nail lesions and can suggest a specific diagnosis. This review focuses on high resolution MRI of nail tumors and tumor-like lesions. We review the nail anatomy and the optimal MRI protocol. We then discuss a variety of tumors and tumor-like lesions in relation to the clinical presentation, anatomic location, histological features and imaging characteristics. We herewith describe common benign tumors (glomus tumor, onychomatricoma, keratoakanthoma, fibroma, subungual exostosis, hemangioma, chondroma, pyogenic granuloma), malignant tumors (subungual melanoma, subungual squamous cell carcinoma), as well as tumor mimics (mucoid cyst, epidermoid cyst). Although not entirely specific, MRI is a valuable tool in treatment planning of these tumors.

The pathogenesis of synovial cysts is largely unknown; however, they have been increasingly thought of as markers of spinal facet instability and typically associated with degenerative spondylosis. We specifically investigated the incidence of concomitant synovial cysts with underlying degenerative spondylolisthesis.A literature search was performed using 4 online databases to assess the association between lumbar synovial cysts and degenerative spinal pathological features. Meta-analyses were performed on the prevalence rates of coexisting degenerative spinal pathological entities and treatment modalities. A random effects model was used to calculate the mean and 95% confidence intervals.A total of 17 studies encompassing 824 cases met the inclusion criteria. The pooled prevalence rates of concurrent spondylolisthesis, facet arthropathy, and degenerative disc disease at the same level of the synovial cysts were 42.5% (range, 39.0%-46.1%), 89.3% (range, 79.0%-94.8%), and 48.8% (range, 43.8%-53.9%), respectively. Among these, patients with coexisting spondylolisthesis were more likely to undergo spinal fusion surgery (vs. laminectomy alone) and reoperation than were patients without spondylolisthesis with a pooled odds ratio of 11.5 (95% confidence interval, 4.5-29.1; P0.0001) and 2.0 (95% confidence interval, 0.9-4.2; P = 0.088), respectively.Patients with a combination of synovial cysts and degenerative spondylolisthesis are more likely to undergo spinal fusion surgery than laminectomy alone compared with patients with synovial cysts and no preoperative spondylolisthesis. Furthermore, patients with synovial cysts and spondylolisthesis are more likely to require additional fusion surgery. The results from the present review lend credence to the argument that synovial cyst herniation might be a manifestation of an unstable spinal level.

A ganglion cyst is rarely the cause of peripheral nerve compression. In the lower extremity, it is important to distinguish clinically the symptoms from a radiculopathy. In the literature, neural damage of the peroneal nerve due to a ganglion cyst has been described. An acute, isolated plegia of the foot/toe dorsiflexors with completely unaffected sensory function - as in our case - has not yet been described. After clinical examination and imaging, the ganglion cyst was surgically removed and the nerve decompressed, which was followed by complete recovery of the motoric function. Peripheral nerve compression due to a ganglion cyst is an important differential diagnosis in peripheral nerve deficit. The therapy of choice is the fastest possible surgical decompression. Recovery is expected within a few weeks.Ein Ganglion ist nur selten Ursache für eine periphere Nervenkompression. An der unteren Extremität ist es wichtig, die Symptomatik klinisch von einer Radikulopathie zu unterscheiden. In der Literatur wurden Ausfälle im Bereich des N. peroneus beschrieben. Eine akute, isolierte Fuß-/Zehenheberparese bei komplett unauffälliger Sensibilität, wie in unserem Fall, wurde bislang noch nicht beschrieben. Nach klinischer und bildgebender Diagnostik erfolgte die operative Entfernung der Zyste und Dekompression des Nervs mit nachfolgend vollständiger Erholung der Motorik. Periphere Nervenkompression durch ein Ganglion ist eine wichtige Differenzialdiagnose bei peripheren Ausfällen. Die Therapie der Wahl ist eine schnellstmögliche operative Dekompression. Eine Erholung ist innerhalb weniger Wochen zu erwarten.

Background Synovial cyst of the hip joint is a rare clinical condition in need of evidence-based guidelines for its diagnosis and management. Normally, synovial cyst of the hip joint requires no treatment, but when it intrudes into surrounding structures, various clinical symptoms appear. Because of its rarity, a symptomatic synovial cyst is often confounded with a tumor as a space-occupying lesion or with other diseases, depending on its various clinical presentations. Therefore, guidelines for the precise diagnosis and appropriate management for synovial cyst of the hip joint are required. Methods We retrospectively studied 7 cases of symptomatic synovial cyst of the hip joint, some of which showed lower limb edema due to mass effect. We compared physical exam findings on presentation, imaging findings, and size and location of the cyst. Results All cases were managed successfully with surgical excision. We found that, instead of the size of the cyst, the location of the cyst was an important contributor to venous compression. The recurrence rate was 0%, and some patients have significantly long follow-up of 2 years, 4 years, 6 years and 10 years, respectively. Conclusions For symptomatic synovial cyst of the hip joint, surgical excision can successfully resolve the symptoms without recurrence. This retrospective study discusses the clinical presentations, diagnostic approaches, and surgical treatment of symptomatic synovial cyst of the hip joint, hence shedding more light on the clinical management of this condition.

Ganglion cysts are common periarticular/peritendinous masses, which are thought to form from myxoid degeneration of collagen that becomes encased by connective tissue.1 This differentiates them from synovial cysts, which are lined by synovium.2,3 The presence of numerous ganglion cysts in multiple locations is very rare and has been termed cystic ganglionosis 4.

Le kyste synovial rétro-achilléen est une formation kystique développée à partir de la bourse rétro-achilléenne. Il représente une étiologie rare de talalgies. Il est très peu rapporté dans la littérature. Nous rapportons le cas d'une jeune femme de 22 ans, souffrant de talalgies gauches rebelles au traitement médical. La radiographie de profil du pied gauche a montré une excroissance osseuse pointue et saillante en haut et en arrière de la grosse tubérosité calcanéenne. L'angle de Chauvaux était à 16 degrés et l'angle de Fowler-Philip était à 82 degrés. Le diagnostic de la maladie de Haglund a été retenu. Au bloc opératoire, l'abord chirurgical était fait par voie dorsale. Une formation kystique retro-achilléenne a été retrouvée et envoyée pour examen anatomo-pathologique. Ce dernier a confirmé la nature de la formation: un kyste synovial. Le geste a été complété par une résection de l'excroissance osseuse. L'évolution clinique était favorable. Notre cas est original car il montre une localisation rare et inhabituelle d'un kyste synovial en extra-articulaire, compliquant la maladie de Haglund.