Percutaneous ultrasound-guided ganglion fenestration in children: initial results.

Abstract

To evaluate our pediatric experience with percutaneous ultrasound-guided fenestration of ganglia (PUGG). Retrospective study of pediatric patients who underwent PUGG from June 2016 to October 2018 at a free-standing tertiary referral academic children's hospital with a minimum of 6months follow-up. Electronic medical records, picture archiving system, and post-procedural calls were utilized for patient demographics, lesion characteristics, procedure details, and recurrence. The procedure itself consisted of assessment by Child Life, application of topical anesthetic cream, sterile preparation and draping, and intra-procedural ultrasound guidance for local anesthetic instillation, ganglion aspiration, fenestration, and intra-remnant steroid instillation. Post-procedure care included an ice pack, compression dressing for 48h, and 4weeks of brace wear and activity restriction. Forty-five patients met the inclusion criteria, ages 3-18years, mean 13.5years, and female to male ratio of 2:1. Ganglion locations consisted of 80% (36/45) in the wrist and 20% (9/45) in other locations (elbow, ankle, and foot). Ninety-eight percent (44/45) of procedures were performed non-sedated, including 20% (9/44) between ages 7 and 11years. 28.9% (13/45) of ganglia recurred, the earliest at 3weeks, the latest at 10months, and an average of 3months' time. No complication occurred and no patients required post-procedural narcotics or Emergency Department visitation for pain control. Percutaneous ultrasound-guided fenestration of ganglia (PUGG) is a safe, minimally invasive alternative to surgical excision in the pediatric population, which can be performed without sedation and does not leave a scar.