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Węgiel A, Zielinska N, Głowacka M, Olewnik Ł. Hypoglossal Nerve Neuropathies-Analysis of Causes and Anatomical Background. Biomedicines 2024; 12:864. [PMID: 38672218 PMCID: PMC11048189 DOI: 10.3390/biomedicines12040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The hypoglossal nerve is the last, and often neglected, cranial nerve. It is mainly responsible for motor innervation of the tongue and therefore the process of chewing and articulation. However, tumors, aneurysms, dissections, trauma, and various iatrogenic factors such as complications after surgeries, radiotherapy, or airway management can result in dysfunction. Correct differential diagnosis and suitable treatment require a thorough knowledge of the anatomical background of the region. This review presents the broad spectrum of hypoglossal neuropathies, paying particular attention to these with a compressive background. As many of these etiologies are not common and can be easily overlooked without prior preparation, it is important to have a comprehensive understanding of the special relations and characteristic traits of these medical conditions, as well as the most common concomitant disorders and morphological traits, influencing the clinical image. Due to the diverse etiology of hypoglossal neuropathies, specialists from many different medical branches might expect to encounter patients presenting such symptoms.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Mariola Głowacka
- Nursing Department, Masovian Academy in Płock, 09-402 Płock, Poland;
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland
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Renuji B, Arif M, Nadarajah J, Balagopal K, Panattil JG. Isolated 12th Cranial Nerve Palsy Due to Skull Base Synovial Cyst. Neurol India 2024; 72:162-164. [PMID: 38443024 DOI: 10.4103/ni.neurol-india-d-23-00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Baishyak Renuji
- Department of Kolenchery Institute of Neurological Diseases, Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam, Kerala, India
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Mungalpara N, Mungalpara D, Naik A, Shah D, Dalal S. The current trend of proximal tibiofibular ganglion cyst: A summary of 7 case series and 61 case reports. J Clin Orthop Trauma 2023; 45:102258. [PMID: 37982030 PMCID: PMC10656265 DOI: 10.1016/j.jcot.2023.102258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 10/07/2023] [Indexed: 11/21/2023] Open
Abstract
Purpose To review the different types of ganglion cysts surrounding the proximal tibio-fibular joint, their management options, outcomes, and recurrence. Design Descriptive analytical review. Results 7 case series consisting of a total of 159 patients and 61 case reports consisting of 80 patients (with three patients having bilateral pathology) were included in this review. (Total cysts 159 + 83 = 242). The mean age was 41 years, and 71 % of the patients were males. 96.5 % of the cases were managed operatively, out of which 98 % of patients felt improvement in local symptoms and 71.5 % had improvement in neurological symptoms. Complete excision of the cyst is the primary mode of operative management. Many added procedures with complete excision are to mitigate the risk of recurrence. The recurrence rate of aspiration, simple excision alone, simple excision with recurrent articular branch neurectomy, and simple excision with PTFJ procedures were 77 %, 56 %, 11.5 %, and 0 %, respectively. Outcomes beyond recurrence were poorly reported. Conclusion There is not enough literature regarding the topic from which any formal systematic review can be done. Our summary suggests that aspiration alone or with steroid injection is associated with the highest recurrence rates among all the procedures. Complete excision with recurrent articular branch neurectomy should be the primary management. Revision cyst excision in isolation is an inadequate treatment option, therefore should be done in conjunction with PTFJ arthrodesis, which reduces the recurrence rates. Better quality studies are needed that report patient-centered outcomes and morbidities following PTFJ procedures.
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Affiliation(s)
- Nirav Mungalpara
- Department of Orthopaedics, University Of Illinois, Chicago, IL, 60612, USA
| | | | - Aarjav Naik
- Department of Orthopaedics, Government Medical College, Surat, Gujarat, India
| | - Daivesh Shah
- Department of Orthopaedics, Swaminarayan Institute of Medical Science, Kalol, Gandhinagar, Gujarat, India
| | - Shaival Dalal
- Princess Wales Hospital, Coity Rd, Bridgend, CF31 1RQ, United Kingdom
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Oliver JD, Forte AJ. A rare cause of unilateral hypoglossal nerve palsy: case report of intraneural ganglion cyst of the hypoglossal nerve and review of the literature. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 6:131-135. [PMID: 32002460 PMCID: PMC6968678 DOI: 10.1080/23320885.2019.1599288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/20/2019] [Indexed: 11/17/2022]
Abstract
Benign lesions of the soft tissue arising in the periarticular space, such as a ganglion cyst, can cause compression of adjacent nerve fascicles passing in the nearby joint space. Intraneural ganglion cysts involving the cranial nerves are particularly rare, with only a few previous cases reported in the literature.
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Affiliation(s)
| | - Antonio J Forte
- Division of Plastic and Reconstructive Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
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Hypoglossal Canal Lesions: Distinctive Imaging Features and Simple Diagnostic Algorithm. AJR Am J Roentgenol 2017; 209:1119-1127. [DOI: 10.2214/ajr.17.18102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Weindling SM, Goff RD, Wood CP, DeLone DR, Hoxworth JM. Is Hypoglossal Nerve Palsy Caused by Craniocervical Junction Degenerative Disease an Underrecognized Entity? AJNR Am J Neuroradiol 2016; 37:2138-2143. [PMID: 27538906 DOI: 10.3174/ajnr.a4885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/30/2016] [Indexed: 11/07/2022]
Abstract
Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease has rarely been reported as an underlying cause. To improve understanding of this entity, we present a retrospective series of 18 patients with hypoglossal palsy in whom twelfth cranial nerve compression within the premedullary cistern or hypoglossal canal, or both, was found secondary to craniocervical junction juxta-articular cysts, retro-odontoid fibrous pseudotumors, and osteophytes. The imaging techniques and characteristic craniocervical junction degenerative disease lesion imaging findings presented here might help clinicians interpreting hypoglossal palsy imaging studies avoid perceptual and interpretive errors commonly found in the present series.
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Affiliation(s)
- S M Weindling
- From the Department of Radiology (S.M.W., R.D.G.), Mayo Clinic, Jacksonville, Florida
| | - R D Goff
- From the Department of Radiology (S.M.W., R.D.G.), Mayo Clinic, Jacksonville, Florida
| | - C P Wood
- Department of Radiology (C.P.W., D.R.D.), Mayo Clinic, Rochester, Minnesota
| | - D R DeLone
- Department of Radiology (C.P.W., D.R.D.), Mayo Clinic, Rochester, Minnesota
| | - J M Hoxworth
- Department of Radiology (J.M.H.), Mayo Clinic Hospital, Phoenix, Arizona
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Desy NM, Wang H, Elshiekh MAI, Tanaka S, Choi TW, Howe BM, Spinner RJ. Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 2016; 125:615-30. [PMID: 26799306 DOI: 10.3171/2015.9.jns141368] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. METHODS In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. RESULTS In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.
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Affiliation(s)
| | | | | | - Shota Tanaka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan; and
| | - Tae Woong Choi
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Robert J Spinner
- Departments of 2 Neurologic Surgery.,Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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Bilgin-Freiert A, Fugleholm K, Poulsgaard L. Case Report: Intraneural Intracanalicular Ganglion Cyst of the Hypoglossal Nerve Treated by Extradural Transcondylar Approach. J Neurol Surg Rep 2015; 76:e180-2. [PMID: 26251801 PMCID: PMC4521000 DOI: 10.1055/s-0035-1555016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/19/2015] [Indexed: 12/04/2022] Open
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.
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Affiliation(s)
- Arzu Bilgin-Freiert
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
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Capek S, Koutlas IG, Strasia RP, Amrami KK, Spinner RJ. An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves. J Neurosurg 2015; 122:1433-7. [DOI: 10.3171/2014.12.jns14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of an intraneural ganglion cyst involving a cranial nerve (V3), which was found to have a joint connection in support of an articular origin within the cranial nerves. An inferior alveolar intraneural cyst was incidentally discovered on a plain radiograph prior to edentulation. It was resected from within the mandibular canal with no joint connection perceived at surgery. Histologically, the cyst was confirmed to be an intraneural ganglion cyst. Reinterpretation of the preoperative CT scan showed the cyst arising from the temporomandibular joint. This case is consistent with the articular (synovial) theory of intraneural ganglion cysts. An anatomical explanation and potential joint connection are provided for this case as well as several other cases of intraneural cysts in the literature, and thus unifying cranial nerve involvement with accepted concepts of intraneural ganglion cyst formation and propagation.
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Affiliation(s)
- Stepan Capek
- Departments of 1Neurosurgery and
- 2International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic; and
| | - Ioannis G. Koutlas
- 3Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Rhys P. Strasia
- 4Center for Oral & Maxillofacial Surgery, Madison, Wisconsin
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Giordano M, Gerganov VM, Samii A, Samii M. Intradural extraneural bilobate ganglion cyst of the atlanto-occipital joint compressing the hypoglossal nerve. J Clin Neurosci 2012; 19:472-3. [DOI: 10.1016/j.jocn.2011.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 04/22/2011] [Indexed: 11/30/2022]
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Gambhir S, Mujic A, Hunn A. An intraneural ganglion cyst causing unilateral hypoglossal nerve palsy. J Clin Neurosci 2011; 18:1114-5. [DOI: 10.1016/j.jocn.2010.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 12/18/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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