Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients

Abstract

Background: Multiple invasive treatments exist for pediatric patients presenting for evaluation of symptomatic wrist ganglia, most commonly surgical excision or percutaneous treatment. Treatment modality is often dictated by patient preference and recurrence rate. Compared with adult literature, treatment outcomes of wrist ganglia in children are less examined. This study examines recurrence rates of wrist ganglia after surgical excision and ultrasound-guided treatment (USGT) in a pediatric population.Methods: A retrospective study of patients referred for wrist ganglia treatment from January 2015 to February 2020 at a single-center children's hospital was performed. Patients aged 0-18 years with a minimum of 1-year follow-up from either USGT or surgical excision were included.Results: Sixty-nine patients underwent surgical excision with 15 (22%) experiencing recurrence. Seventy-seven patients underwent USGT with 26 (34%) experiencing recurrence. There was no statistical difference between recurrence rates between the two groups (p = 0.140). Thirty of 146 (20.5%) patients underwent a subsequent excision procedure where 18 (60%) experienced no recurrence, 4 (13%) experienced recurrence, and 8 (26%) had insufficient follow-up of less than one year. All 7 patients treated in clinic with aspiration without ultrasound guidance required subsequent intervention.Conclusion: USGT of wrist ganglia is a reasonable treatment choice for pediatric patients and has a similar recurrence rate to surgical excision. For patients that require subsequent treatment, recurrence rates are also similar between USGT and surgical excision. Parents of children with wrist ganglia should be educated about treatment options and recurrence rates, and patients should have age-appropriate involvement in management decisions regarding treatment of wrist ganglia.Level of Evidence: Level III Key Concepts•Surgical excision and USGT of wrist ganglia have similar recurrence rates in the pediatric population.•Recurrence rates range from 22-33% in patients after a single procedure.•There is a low rate of recurrence when recurrent ganglia are treated with surgical excision.