Acta Neurochirurgica

, Volume 161, Issue 10, pp 2129–2132 | Cite as

The medial safe zone for treating intraneural ganglion cysts in the tarsal tunnel: a technical note

  • Ross C. Puffer
  • Robert J. SpinnerEmail author
Technical Note - Peripheral Nerves
Part of the following topical collections:
  1. Peripheral Nerves



Intraneural ganglion cysts in the tarsal tunnel are rare but are being increasingly reported. The cysts involve the tibial or plantar nerves and are most commonly derived from a neighboring (degenerative) joint, (i.e., the tibiotalar or subtalar) via an articular branch arising from the medial aspect of the nerve. We describe a safe zone for approaching these cysts in the tarsal tunnel that allows for identification of the joint connection without injury to important distal branches.


We present a case of an intraneural ganglion cyst within the tarsal tunnel in a patient with symptoms consistent with tarsal tunnel syndrome. Using intraoperative photographs and artist rendering, we describe a technique to safely disconnect the abnormal joint connection while preserving the important distal branches of the tibial nerve.


The safe zone for the tibial nerve in the tarsal tunnel can be exposed by mobilization and gentle retraction of the vascular bundle. In cases of intraneural ganglion cysts, all apparent connections between the nerve and degenerative joints within this safe zone can be resected without injury to important distal nerve branches.


Intraneural Ganglion Cyst Tibial Tarsal Tunnel 


Compliance with ethical standards

IRB approval was obtained for this study.

All patients included signed consent forms for the use of non-identifying medical information in medical research, including this study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Mayo ClinicRochesterUSA

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