What is the role of surgery in the treatment of ganglion cyst?

Updated: Feb 24, 2020
  • Author: Renee Genova, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Open removal has been the surgical treatment of choice for ganglion cyst removal, with arthroscopy offering some benefits, including a reduction in intraoperative risks and postoperative complications. Recurrence is seen with all treatment modalities and has been reported to be as high as 40% following open excision of dorsal wrist ganglia. [4, 6]

Regardless of whether the ganglion is removed via open surgery or via arthroscopic excision, when a stalk is visualized, it should be completely removed, or the cyst should be removed at the origin to reduce the risk of recurrence. A recurrence rate of 13-40% has been observed following removal of entire cysts, but when a portion of the capsule is removed as well, recurrence rates decrease to as low as 4%. [2] Some surgeons close the capsule; however, this can lead to reduced, or loss of, wrist flexion, so most surgeons do not close the resulting defect. [2]

Brief splinting of 3-7 days is recommended for both open and arthroscopic ganglionectomy, but it seems that wrist motion within 3-5 days after the procedure can prevent stiffness. [2, 5, 10] A volar ganglion cyst is much more likely to recur than a dorsal ganglion cyst, [4] and care must be taken to protect the radial and ulnar neurovascular bundles because radial artery laceration is the most common vascular complication in volar carpal excision of ganglia. [2] (See the images below.)

Volar cyst from pisotriquetral joint. Volar cyst from pisotriquetral joint.
Lumen of pisotriquetral cyst. Lumen of pisotriquetral cyst.

Compared to an open ganglionectomy, arthroscopy uses smaller incisions and therefore leaves smaller scars; arthroscopy also allows better visualization and easier identification of other intra-articular pathologies, such as triangular fibrocartilage complex (TFCC) tears or ligament injuries. [4] The scapholunate interosseous ligament is of concern with open dorsal ganglionectomy, and the arthroscopic procedure provides protection of this ligament and allows for better control of excision. [10]

Although arthroscopic excision can be performed for radiocarpal volar ganglia, an open procedure is usually used. [9] When surgery is indicated for a mucous cyst, as it would be if there is nail deformity, pain, or skin thinning, it is important to also remove the osteophytes in an effort to significantly reduce the rate of recurrence.


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