Case Report: Intraneural Intracanalicular Ganglion Cyst of the Hypoglossal Nerve Treated by Extradural Transcondylar Approach

Abstract

We report a case of an intraneural ganglion cyst of the hypoglossal canal. The patient presented with unilateral hypoglossal nerve palsy, and magnetic resonance imaging showed a small lesion in the hypoglossal canal with no contrast enhancement and high signal on T2-weighted imaging. The lesion was assumed to be a cystic schwannoma of the hypoglossal nerve. Stereotactic irradiation was considered, but in accordance with the patient's wishes, surgical exploration was performed. This revealed that, rather than a schwannoma, the patient had an intraneural ganglion cyst, retrospectively contraindicating irradiation as an option. This case illustrates a very rare location of an intraneural ganglion cyst in the hypoglossal nerve. To our knowledge there are no previous reports of an intraneural ganglion cyst confined to the hypoglossal canal.

Keywords

intraneural ganglion cyst - hypoglossal nerve palsy - hypoglossal canal - transcondylar approach

• References

• 1 Harbaugh KS, Tiel RL, Kline DG. Ganglion cyst involvement of peripheral nerves. J Neurosurg 1997; 87 (3) 403-408
• 2 Spinner RJ, Amrami KK, Kliot M, Johnston SP, Casañas J. Suprascapular intraneural ganglia and glenohumeral joint connections. J Neurosurg 2006; 104 (4) 551-557
• 3 Spinner RJ, Atkinson JLD, Tiel RL. Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 2003; 99 (2) 330-343
• 4 Spinner RJ, Carmichael SW, Atkinson JLD. Intraneural ganglion cyst [letter]. J Neurosurg 2006; 104 (6) 990-992 ; author reply 992
• 5 Mujic A, Hunn A, Liddell J, Taylor B, Havlat M, Beasley T. Isolated unilateral hypoglossal nerve paralysis caused by an atlanto-occipital joint synovial cyst. J Clin Neurosci 2003; 10 (4) 492-495
• 6 Elhammady MS, Farhat H, Aziz-Sultan MA, Morcos JJ. Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst. J Neurosurg Spine 2009; 10 (3) 234-239
• 7 Gambhir S, Mujic A, Hunn A. An intraneural ganglion cyst causing unilateral hypoglossal nerve palsy. J Clin Neurosci 2011; 18 (8) 1114-1115
• 8 Combarros O, Alvarez de Arcaya A, Berciano J. Isolated unilateral hypoglossal nerve palsy: nine cases. J Neurol 1998; 245 (2) 98-100
• 9 Omura S, Nakajima Y, Kobayashi S, Ono S, Fujita K. Oral manifestations and differential diagnosis of isolated hypoglossal nerve palsy: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84 (6) 635-640
• 10 Rachinger J, Fellner FA, Trenkler J. Dumbbell-shaped hypoglossal schwannoma. A case report. Magn Reson Imaging 2003; 21 (2) 155-158
• 11 Baghel PS, Gupta A, Tripathi VD, Reddy DS. Hypoglossal schwannoma presenting as hemi-atrophy of the tongue. Neurol India 2013; 61 (3) 324-325
• 12 Krauss WE, Atkinson JL, Miller GM. Juxtafacet cysts of the cervical spine. Neurosurgery 1998; 43 (6) 1363-1368
• 13 Cudlip S, Johnston F, Marsh H. Subaxial cervical synovial cyst presenting with myelopathy. Report of three cases. J Neurosurg 1999; 90 (1, Suppl): 141-144
• 14 Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 1983; 13 (3) 322-326
• 15 Sypert GW, Leech RW, Harris AB. Posttraumatic lumbar epidural true synovial cyst. Case report. J Neurosurg 1973; 39 (2) 246-248
• 16 Baldauf J, Junghans D, Schroeder HW. Endoscope-assisted microsurgical resection of an intraneural ganglion cyst of the hypoglossal nerve. J Neurosurg 2005; 103 (5) 920-922
• 17 Nonaka Y, Grossi PM, Filomena CA, Friedman AH, Fukushima T. Unilateral hypoglossal nerve palsy caused by an intraneural ganglion cyst. J Neurosurg 2010; 113 (2) 380-383