Popliteal Artery Compression Caused by Intraneural Ganglion Cyst of the Tibial Nerve

Intraneural ganglion cysts are rare, benign mucinous cysts that arise within the epineurium of peripheral nerves. They most commonly involve the peroneal nerve, whereas involvement of the tibial nerve is exceptionally rare. Patients typically present with neurological deficits involving motor and sensory function of the affected nerve. We present a case of an intraneural ganglion cyst of the tibial nerve manifesting primarily with atypical, vascular compression-like symptoms of intermittent claudication. A 43-year-old patient was referred to our department with a 1-year history of exertional, cramp-like pain in the left calf. The pain occurred consistently within minutes of walking or running and subsided with rest, mimicking intermittent claudication. Duplex sonography and subsequent magnetic resonance imaging revealed an intraneural ganglion cyst of the tibial nerve originating from the superior tibiofibular joint, showing compression of the popliteal artery. On magnetic resonance imaging, compression of the popliteal artery to less than a third of its physiological diameter was demonstrated. Definitive surgical management involved decompression of the intraneural cyst and disconnection of the articular branch. Postoperatively, the patient's intermittent claudication symptoms ceased. Intraneural ganglion cysts of the lower extremity represent a rare cause of neurological symptoms. This case report showed that they can also compress adjacent vascular structures, thereby mimicking intermittent claudication. These atypical symptoms can lead to an initial suspicion of a vascular etiology and hence pose a risk for misdiagnosis. Decompression of the ganglion and addressing the articular branch are essential steps to prevent recurrence and provide definitive symptom relief.