Purpose or Case Report: Percutaneous ultrasound-guided fenestration of ganglia (PUGG) of the pediatric wrist is a minimally invasive, safe alternative to surgical excision which does not require sedation or leave a scar. The purpose of this study is to assess relative risk for recurrence based on pre-procedural ultrasound imaging variables and procedural factors.
Methods & Materials: Retrospective study of patients who underwent PUGG from 11/2018 through 1/2023 at an academic children’s hospital with a minimum of 6 months of follow-up. Patient demographics, lesion characteristics, procedure details, and recurrence data were collected.
Results: Of the 208 children who underwent successful PUGG, 149 were included with available clinical follow-up (114 dorsal and 35 volar wrist ganglia). Of the factors we analyzed that could contribute to recurrence versus no recurrence after PUGG, only the presence of a ganglion for <6 months prior to procedure was statistically significant (recurrence rate 53.8%, RR=1.35, p=0.02, 95%CI=1.02,1.79). The remaining factors (ganglion size, needle size, presence of septations, aspirated versus non-aspirated, dorsal versus volar location, and patient gender) were not statistically significant. Furthermore, in our subset analysis, there was a significant difference between the risk of recurrence for ganglia >1 cm and present for ≥6 months prior to procedure, versus not (RR=1.36, p=0.01, 95%CI=1.06,1.74). Additionally, there was no significant relative risk when analyzing all variables with respect to ganglia recurrence which required subsequent additional aspiration and/or surgical removal.
Conclusions: PUGG has greater success for ganglia that had been present for <6 months. PUGG is a safe, minimally invasive procedure that does not require sedation and does not incur cosmetic alteration to the wrist. With appropriate patient selection, PUGG serves as a valuable first-line therapeutic role for the elective treatment of ganglia of the wrist.