Compression Syndrome of the Left Common Peroneal Nerve Caused by Intraneural Cavernous hemangiomas: A Case Report

• Published in: Orthopedics & Traumatology Vol. 51; no. 2; pp. 253 - 258
• Main Authors: Arinaga, Makoto, Matsuzaki, Akio
• Format: Journal Article
• Language: English
• Published: West-Japanese Society of Orthopedics & Traumatology 2002
• Subjects: cavernous; common peroneal nerve; hemangioma; intraneural
• ISSN: 0037-1033; 1349-4333
• DOI: 10.5035/nishiseisai.51.253

Intraneural hemangioma is an extremely rare condition. To our knowledge, only one case of hemangioma within the common peroneal nerve has been reported. We present an additional case. A 48-year-old male was seen on May 20, 1999 complaining of severe left knee pain and paresthesia on the lateral aspect of the left lower leg and dorsum of the foot. Physical examination revealed swelling and marked tenderness of the left common peroneal nerve in the lateral proximal region of the popliteal fossa. A Tinel's sign along the nerve in the popliteal fossa was present. Hypesthesia over the peroneal nerve distribution and a weakness of the toe extensor was present. He was diagnosed as compression syndrome of the common peroneal nerve. After failed conservative treatment with vitaminn B1, 12 and antiinflammatory drugs, surgical decompression was carried out. At surgery, in the proximal region of the popliteal fossa, a dark red mass of about 2cm surrounding the common peroneal nerve was noted, and distal to this tumor another three smaller bluish masses on the nerve were also noted. Decompression of the nerve by opening the epineurium and incision of aponeurotic part of the biceps muscle were carried out, because dissection of the tumor without injury to the nerve was considered imposssible. Postoperative course was uneventful. However after five months, disabling pain recurred and second operation was carried out. Intrafascicular dissection of the tomor was intended but bleeding from the cavities of the tumor prevented further dissection, and ligation of the nutrient vessels of the nerve near the tumor was carried out. After deflation of the pneumatic tourniquet, the size of the tumor was reduced and blood supply of the nerve was seen to be normal. Five months after the second operation, the patient had no pain and no sensory disturbance.