Percutaneous ultrasound-guided fenestration of ganglia in the wrist in pediatric patients: An update.

Abstract

Percutaneous ultrasound-guided fenestration of ganglia (PUGG) in children has been a first line treatment option at our institution in lieu of surgical resection. The purpose of our study is to report our efficacy and safety of PUGG in symptomatic pediatric wrist ganglia, and to determine if any pre-procedural ultrasound findings help predict ganglia recurrence. A retrospective study of children who underwent PUGG of the wrist from May 2023 through November 2024 at an academic children's hospital was performed. Patients were excluded if the ganglion was ruptured on pre-PUGG imaging and were <math xmlns="http://www.w3.org/1998/Math/MathML"><mo>≥</mo></math> 19 years old. Patient demographics, pre-procedure ultrasound characteristics, procedure details, and recurrence/complications were collected by utilizing the electronic medical record and PACS. Continuous and categorical data were assessed with a significance level set to 0.05. There were 105 children (mean age (years):14.1 + / - 3.0 (4-18)) who underwent successful PUGG with 97.1% performed without sedation. Of these, 70 patients had optional clinical follow-up. Recurrence for the total population was 26.7% (28/105), and subset analysis for those patients with optional clinical follow-up was 40.0% (28/70). Ganglion symptom duration, ganglion size, presence of septations, internal debris, PUGG needle size, and steroid dosage did not statistically predict recurrence. Temporary numbness (2.9%) and site pain (7.6%) were the most common complications, and no children reported cosmetic scarring of the wrist. PUGG is a safe, minimally invasive procedure to treat symptomatic pediatric wrist ganglia. With appropriate patient selection, PUGG can serve as a valuable first-line elective therapeutic treatment for wrist ganglia.