Ganglionectomy without Repairing the Bursal Defect: Long-term Results in a Series of 124 Wrist Ganglia

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.

Tumor gigantocelular sinovial do joelho / Synovial giant cell tumor of the knee

Tumor gigantocelular sinovial é uma neoplasia benigna, raramente sendo relatada na forma de metástase maligna. A localização mais comum de ocorrer um tumor gigantocelular sinovial é na mão e as mais infrequentes são tornozelo e joelho. No presente estudo os autores têm como objetivo descrever um caso raro de tumor gigantocelular sinovial localizado no joelho e o tratamento escolhido. A artroscopia demonstrou, nesse caso, ser o método ideal para o tratamento da lesão, uma vez que permitiu abordagem pouco agressiva e, ao mesmo tempo, boa visualização de todos os compartimentos da articulação do joelho e a completa ressecção do tumor.

Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection.

Quiste sinovial extraarticular por fistula interna trans tendon rotuliano postraumatica: reporte de caso / Post-traumatic synovial cyst caused by internal trans patellar tendon fistula

Se describe un caso de formación de un quiste mucoide extraarticular originado en un fístula sinovial interna postraumática a través del tendón rotuliano. Los tratamientos previos con punciones, estudio del líquido e inmovilización lograban remisiones parciales y temporales, con recidiva de la tumoración. El estudio detallado de RMN pudo hacer el diagnóstico objetivando una fistula de origen articular a través del tendón rotuliano. La resección abierta del quiste con su origen fistuloso y el cierre del tendón fue efectiva en la solución de la patología.

Intraspinal synovial cysts: a retrospective study.

BACKGROUND: We report the clinical presentation, radiographic studies, intraoperative findings, histopathological analysis, and post-treatment outcome in 26 patients diagnosed with spinal synovial cysts (SSCs). AIMS: To describe the clinical presentation, radiographic studies, operative findings, and postoperative follow-up in 26 patients with SSCs. SETTINGS AND DESIGN: The study was retrospective in design, involving chart review. Individual patient data was tabulated and patterns were recognized. MATERIALS AND METHODS: The charts for 26 patients who underwent surgical extirpation of SSC between April 1993 and October 2002 were retrospectively reviewed. Specifically, initial clinical presentation, pertinent radiographs (X-rays, magnetic resonance imaging, computed tomography), intraoperative findings, histopathology, and postoperative follow-up were noted. Statistical Analysis Used: Patient data was tabulated and analyzed for patterns in demographics, symptoms and histopathology. RESULTS: SSCs were more common in females than males (17:9 ratio). Presenting symptoms were back pain with radiculopathy in 13 (50%), radicular pain in the absence of back pain in 10 (38%), and back pain without radicular pain in three (11%). In addition, 17 patients (65%) had sensory deficit, and 9 (35%) had motor deficit. Most SSCs occurred at the lumbar (19/26) or lumbosacral (5/26) regions, with only 2 (2/26) in the thoracic region. One patient had bilateral SSC at the L4-5 level. Intraoperatively, each cyst was located adjacent to a degenerated facet joint. These lesions could grossly be identified intraoperatively and histopathological confirmation was achieved in all the cases. CONCLUSIONS: SSCs are important lesions to consider in the differential diagnosis of lumbar epidural masses and surgical resection leads to significant improvement in the majority of cases.

Lumbociática derecha producida por quiste sinovial vertebral. Comunicación de un caso / Rigth lumbociatic produced by vertebral synovial cyst: Comunication of a case

Primer caso tratado quirúrgicamente. Comunicamos este caso femenino de 71 años de edad con severa clínica lumbociática derecha con anestesia del área lateral del muslo con 1 año de evolución. Su clásica posición posterior o postero-lateral en la Resonancia Magnética, permite descargar la composición discal. El tratamiento quirúrgico, extirpación del quiste produjo notable recuperación inmediata al paciente con seguimiento de 8 meses. Se trata del primer caso quirúrgico comunicado en la literatura local