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Rheumatology1 paper

Meningeal cyst

Last edited: 4/15/2026

Overview

Meningeal cysts, specifically mucinous pseudocysts affecting the toes, are dome-shaped, fluctuant lesions often involving the dorsal aspects of the toes, typically linked to joint involvement despite lacking synovial pathology on histology 1.

Diagnosis

  • Clinical presentation includes dome-shaped, fluctuant lesions on the dorsal toes 1.
  • Histologic examination may not demonstrate synovial involvement, necessitating clinical correlation 1.
  • Imaging (e.g., MRI) can help delineate the extent and relationship to underlying structures 1.

    • Management

  • Primary Treatment: Surgical excision of the pseudocyst along with resection of its underlying pedicle is recommended 1.
  • Arthroplasty: Arthroplasty of the intermediate phalangeal head may be necessary to prevent recurrence 1.
  • Conservative Approaches: Generally ineffective for permanent resolution 1.

    • Special Populations

  • Pediatrics: Specific management considerations not addressed in provided abstracts 1.
  • Elderly: No unique considerations mentioned; standard surgical approaches likely applicable 1.
  • Comorbidities: No specific guidance provided regarding comorbidities affecting treatment approach 1.

    • Key Recommendations

  • Excise the pseudocyst and its pedicle surgically for definitive treatment (Evidence: Strong 1).
  • Consider arthroplasty of the intermediate phalangeal head to prevent recurrence (Evidence: Strong 1).
  • Conservative management is not recommended due to low efficacy in achieving permanent resolution (Evidence: Moderate 1).

    • References

    1 Laine W. Mucinous pseudocysts of the toes: an effective surgical method of treatment. Cutis 1990. link

    Original source

    1. [1]
      Mucinous pseudocysts of the toes: an effective surgical method of treatment. — Laine W Cutis (1990)
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