Simultaneous laparoscopic and arthroscopic excision of a huge juxta-articular ganglionic cyst compressing the sciatic nerve: A case report

Figure 1 Preoperative T2-weighted Magnetic resonance image of the lesion. The cystic lesion is seen as 5 cm × 5 cm × 4.6 cm sized with high signal intensity extending to greater sciatic notch. Stalk-like structure extended from left hip joint to main cyst lesion. A: TSE SPAIR transverse; B: TSE SPAIR transverse; C: TSE FS coronal; D: TSE sagittal.

Figure 2 Intrapelvic - Laparoscopic sciatic nerve decompression of a huge ganglionic cyst. A: A tennis-ball sized cystic lesion with yellowish thigh gelatinous fluid was densely adhesive to adjacent nerve; B: Space occupying cyst was excised. Obturator nerve (Blue arrow).

Figure 3 Histologic findings. A: Microscopic examination showing cystically dilated fibrous tissues (hematoxylin and eosin stain, original magnification: × 40); B: The cyst wall is composed of fibroblasts, and the true epithelial lining is lacking (hematoxylin and eosin stain, original magnification: × 100).

Figure 4 Extrapelvic - Diagnostic arthroscopy and endoscopic sciatic nerve decompression. A: Fibrovacular networks (Bird’s nest) adhered the sciatic nerve; B: Ganglionic mass compressed the sciatic nerve; C: Cystic portion was aspirated using a long spinal needle; D: Sciatic nerve was decompressed by aspiration of mass.

Figure 5 Postoperative T2-weighted Magnetic resonance image. A: Magnetic resonance imaging finding shows that previously seen cystic mass is completely resected; B: Severely thickened left sciatic nerve is seen at right before greater sciatic foramen level and edematous change is accompanied around; C: Coronal view. Severe edema is around perifascicular fat which is covering nerve; D and E: Paralabral cyst. The cystic structure connected to hip joint with stalk stretch out to left ischial spine level. Yellow arrow indicates remnant cyst after excised multiple ganglionic masses in the deep gluteal space.