Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous ultrasound-guided ganglion fenestration in children: initial results

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate our pediatric experience with percutaneous ultrasound-guided fenestration of ganglia (PUGG).

Materials and methods

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 6 months 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 48 h, and 4 weeks of brace wear and activity restriction.

Results

Forty-five patients met the inclusion criteria, ages 3–18 years, mean 13.5 years, 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 11 years. 28.9% (13/45) of ganglia recurred, the earliest at 3 weeks, the latest at 10 months, and an average of 3 months’ time. No complication occurred and no patients required post-procedural narcotics or Emergency Department visitation for pain control.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nelson CL, Sawmiller S, Phalen GS. Ganglions of the wrist and hand. J Bone Joint Surg Am 1972;54(7):1459-64.

  2. Singhal R, Angmo N, Gupta S, Kumar V, Mehtani A. Ganglion cysts of the wrist: a prospective study of a simple outpatient management. Acta Orthop Belg 2005;71(5):528-34.

  3. Tophoj K, Henriques U. Ganglion of the wrist - a structure developed from the joint. Acta Orthop Scand 1971;42(3):244-50.

  4. Andren L, Eiken O. Arthrographic studies of wrist ganglions. J Bone Joint Surg Am 1971;53(2):299-302.

  5. McEvedy BV. The simple ganglion. A review of modes of treatment and an explanation of the frequent failures of surgery. Lancet 1954;266(6803):135-6.

  6. Osterman AL, Raphael J. Arthroscopic treatment of dorsal ganglion of the wrist. Hand Clin 1995;11(1):7-12.

  7. Meyerson J, Pan YL, Spaeth M, Pearson G. Pediatric ganglion cysts: a retrospective review. HAND 2019;14(4):445-448.

  8. Neto N, Nunnes P. Spectrum of MRI features of ganglion and synovial cysts. Insights Imaging. 2016;7:179–86.

    Article  Google Scholar 

  9. Zinger G, Michailevich M, Bregman A, Yudkevich G, Steinberg K, Peyser, A. Wrist ganglia in children: nonsurgical versus surgical treatment. J Hand Surg Am 2019;45(6):551.e1-551.e5.

  10. Calif E, Stahl S, Stahl S. Simple wrist ganglia in children: a follow-up study. J Pediatr Orthop 2005;14(6):448-50.

  11. MacCollum MS 1977. Dorsal wrist ganglions in children. J Hand Surg Am 1977;2(4):325.

  12. Satku K, Ganesh B. Ganglia in children. J Pediatr Orthop 1985;5(1):13-5.

  13. Wang AA, Hutchinson DT. Longitudinal observation of pediatric hand and wrist ganglia. J Hand Surg Am 2001;26(4):599-602.

  14. Cypel T, Mrad A, Somers G, Zuker R. Ganglion cyst in children: reviewing treatment and recurrence rates. Can J Plast Surg, 2011;19(2):53-5.

  15. Coffey MJ, Rahman MF, Thirkanna SM. Pediatric ganglion cysts of the hand and wrist: an epidemiologic analysis. Hand 2008;3(4):359-62.

  16. Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg 1997;7(4):231-8.

  17. Colberg RE, Sanchex CF, Lugo-Vicente H. Aspiration and triamcinolone acetonide injection of wrist synovial cysts in children. J Pediatr Surg 2008;43(11):2087-90.

  18. MacKinnon AE, Azmy A. Active treatment of ganglia in children. Postgrad Med J. 1977:53(621):378-81.

  19. Zeidenberg J, Aronowitz JG, Landy DC, Owens PW, Jose J. Ultrasound-guided aspiration of wrist ganglions: a follow-up survey of patient satisfaction and outcomes. Acta Radiol. 2016:57(4):481-6.

  20. Jose J, Fourzali R, Lesniak B, Kaplan L. Ultrasound-guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve. Skelet Radiol 2011;40(11):1473-8.

  21. Mooney ML, Jacobs CA, Prusick VW, Riley SA. Pediatric ganglion cyst recurrence: location isn’t the only risk factor. J Pediatr Orthop 2020;40(7):340-343.

  22. Trivedi NN, Schreiber JJ, Daluiski A. Blunt force may be an effective treatment for ganglion cysts. HSS J 2016;12(2):100-4.

  23. Barnes WE, Larsen RD, Posch J. Review of ganglia of the hand and wrist with analysis of surgical treatment. Plast Reconstr Surg 1964;34:570-8.

  24. Petricig P, Pepe E. First choice treatment of the pediatric wrist ganglia. Minerva Pediatr. 2006:58(4):379-83.

  25. Rosson JW, Walker G. The natural history of ganglia in children. J Bone Jt Surg Br. 1989:71(4):707-8.

Download references

Author information

Authors and Affiliations

  1. Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA

    Erica K. Schallert, Melissa C. Cano, Matthew G. Ditzler, Siddharth P. Jadhav & J. Herman Kan

  2. Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave West Wing, Rm 279, Miami, FL, 33136, USA

    Jean Jose

Authors
  1. Erica K. Schallert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa C. Cano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew G. Ditzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siddharth P. Jadhav
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean Jose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Herman Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erica K. Schallert.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schallert, E.K., Cano, M.C., Ditzler, M.G. et al. Percutaneous ultrasound-guided ganglion fenestration in children: initial results. Skeletal Radiol 50, 1169–1175 (2021). https://doi.org/10.1007/s00256-020-03662-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03662-y

Keywords

Search

Navigation