Prognosis

There are no reported cases of malignant transformation of untreated cysts.

Conservative management

With observation, spontaneous resolution has been reported in up to 58% of adults and up to 93% of children over a 9- to 12-month period.[26][27][28]

Cyst puncture and aspiration

If the original procedure is not successful, multiple treatments may be required. Puncture of dorsal ganglion cysts has been reported to have a 13% success rate with single aspiration. This can be increased to approximately 40% if the wrist is splinted for 3 weeks afterwards, and approximately 85% with up to 3 treatments.[26][29][30]

Surgical excision

Recurrence rates vary, depending on cyst location and the ability to fully excise the entire cyst and stalk (e.g., sometimes volar cysts are so adherent to the radial artery that complete excision is not possible).

One systematic review reported pooled recurrence rates of 9% and 20% for arthroscopic excision and open surgery of dorsal ganglion cysts, respectively.[35] When low quality studies and/or those with high risk of bias were excluded, recurrence rates were 7.9% for arthroscopic surgery and 9.8% for open surgery.[35] In paediatric patients with wrist ganglia, the patient’s age is an important factor in recurrence, with teenagers having higher recurrence rates.[34]​​

The incidence is decreased when a cuff of normal tissue is removed along with the stalk of the ganglia. However, care must be taken to avoid over-aggressive resection of the scapholunate interosseous ligament or a resultant scapholunate diastasis may develop.

Recurrence rates of volar ganglia after open treatment are slightly higher than for dorsal ganglia, ranging from 7% to 19%.[13][38]

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