Outcomes and Recurrence of Pediatric Ganglion Cysts Treated with Aspiration or Surgical Excision: A Retrospective Review with Prospective Follow Up
Scott Dart, MD1; Darren Thomas, MD2; R Christopher Chadderdon, MD2
1Atrium Health, Charlotte, NC, 2OrthoCarolina Hand Center, Charlotte, NC
Introduction: Ganglion cysts of the hand and wrist are common benign lesions occurring in adults but are less common in the pediatric population. Data surrounding outcomes of treatment options in the pediatric population are limited to small cohort sizes. Our purpose was to describe our institutional experience and assess effects of aspiration and surgical treatments on recurrence and function.
Methods: This is a retrospective cohort analysis via chart review with a prospective follow-up phone survey. ICD9 codes were used to identify patients with a diagnosis of ganglion cyst of the wrist or hand with inclusion criteria being <18 years old at diagnosis and minimum 2 years follow-up. Retrospective chart review was performed to gather baseline demographics, age at diagnosis, location of ganglion and types of treatments performed. A prospective follow up phone survey was performed assessing for recurrence, symptoms (VAS pain scale) and functional scores (QuickDASH and SANE scores). Two sample T-test and Wilcoxon rank sum were employed to compare the aspiration and surgically treated groups.
Results: Retrospective analysis was performed for the 542 records (537 patients) identified with 63.7% being female and a median age of 15. Majority (91.3%) were ganglion of wrist/hand with 76.9% of those being dorsal wrist ganglion. Initial VAS pain score was 5.5 (out of 10) for the aspiration group and 5 (out of 10) for the surgical group. Aspiration was performed on 414 (76.4%) of patients with 59 (14.3%) undergoing second aspiration, 12 (3.9%) underwent a third. 109 (26.3%) of the patients who received an aspiration eventually underwent surgical excision. A total of 221 patients underwent surgical excision with a median of 4 months from initial presentation to surgery. Six (2.7%) of these patient underwent a second surgery. To date, 75 patients have completed follow up surveys showing median VAS of 1, median SANE of 100 and QuickDASH of zero with no statistical differences seen in any of the patient reported outcome scores when comparing aspiration to surgical treatment.
Conclusions: As a secondary referral center, most of our patients presented with pain symptoms related to their ganglion cyst and often were seeking treatment. Most patients were initially treated with ganglion aspiration although over 25% eventually required surgical excision. Ganglion cyst excision had a very low recurrence rate in patients followed-up at our institution. Regardless of treatment, all patients displayed good function and minimal pain at follow up. Prospective data collection is still on going.
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