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Pediatric Ganglion Cysts: A Single Surgeon Experience
Joseph Meyerson, MD1; Linda Pan, BS1; Maya Spaeth, MD2; Gregory Pearson, MD1
1The Ohio State University, Columbus, OH 2Nationwide Childrens, Columbus, OH

Background: Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful, interfering with range of motion or parental concerns exist. Reported recurrence rates after surgical removal of pediatric ganglion cysts varies widely in the literature. Notably recurrence rates are higher for children than adults, ranging from as low as 6% to as high as 35%.

Methods: A retrospective review of a single pediatric hand surgeon's patients undergoing excision of primary and recurrent ganglion cysts was examined from 2010-2015. Variables measured included patient age at diagnosis of ganglion cyst, time to presentation, location of cyst, hand dominance, previous therapy, previous surgery, length of surgery, tourniquet time, length of follow up, any associated complications, and recurrence of cyst.

Results: Ninety-six patients were identified with an average age of diagnosis 10.2 years, age at surgery 11.8 years and 84.8% were right handed. Females made up of 72.9% of the patients. Cysts were right-sided in 43.8% of cases. Indications for surgery: 95.8% for pain or decreased range of motion, 4.2% for cosmetic or parental concern. Seventy-five percent of the cases were dorsally located with the remaining 24.2% being volar. Of the 96 patients, four complications occurred: 2 dysthesias, 1 infection, 1 hypertrophic scar and 5 recurrences (5.3%). Tourniquet time was on average 9.8 minutes longer for cases that resulted in recurrence. Multivariate analysis of the data demonstrated a 35% increased risk of recurrence with patients who had a previous aspiration (p<0.0378).

Conclusions: This is the largest series reported of a single pediatric hand surgeon's outcomes of pediatric wrist ganglion cysts. Our recurrence rate of 5.3% is low for a pediatric population indicating potential merit in this surgeon's operative and postoperative techniques. This study parallels reports in the literature with a predilection of cysts in females and higher rates of volar cysts in pediatric cases compared to adults. Previous studies indicate observation as an appropriate first line treatment in pediatric patients. Symptomatic cysts or cysts remaining longer than one year should be considered for excision, which were the vast majority of our study. We demonstrate significantly increased rates of recurrence when a cyst had been previously aspirated possibly from scarring and disruption of planes resulting in difficult dissection, increased tourniquet times and incomplete excision.

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