Definition and Overview
A ganglionectomy is a surgical procedure used to remove a ganglion or a ganglion cyst that form on the hand, foot, or wrist. Although it is not the primary form of treatment initially prescribed to patients, surgery becomes necessary when the patient’s condition fails to improve with other treatment methods. The procedure can be considered as either simple or complex, depending on the size and location of the ganglion cyst.
Ganglion cysts, which are benign or non-cancerous, are also called ganglia or synovial cysts. They are closed, swollen, fluid-filled growths that usually form under the skin, originating from the sheath of a joint or tendon. The sheath is the thin elastic tissue wrapped around the joints and tendons. Its inner lining is called the synovial membrane. The cyst, which is often trigged by the herniation of the synovium, usually stays attached to the said lining. It also contains a clear, sticky fluid with a jelly-like consistency, which is similar to the fluid found in the joints, knees, and shoulders.
Who Should Undergo and Expected Results
A ganglionectomy is beneficial for patients who suffer from:
- Chronic pain affecting the ganglion
- Ganglion cysts
Ganglion cysts may occur singularly or in clusters/lobules connected by ducts. They often cause:
- A noticeable bump or mass, usually soft and spongy, and stays in place
- Pain, usually constant and worsens with movement because the cyst is pressing on the arteries, nerves, or veins in the affected area
- Restricted joint movement, especially if the cyst is connected to a tendon
These cysts most often form on:
- The back of the hand
- At the wrist joint
- On the palm side of the wrist
- On the palm near the base of the fingers
- The thumb
- The fingertips just below the cuticle
- The outside of the ankle
- The outside of the knee
- The shoulder
It is not clear why ganglion cysts form, but it has so far been associated with repetitive joint movements, trauma, and inflammatory diseases such as rheumatoid arthritis. It also more common among females between 20 and 40 years of age, and very rarely affect children.
Patients who develop ganglion cysts are initially prescribed with other treatment methods, including:
- Steroid injections, specifically cortisone injections
- Cyst aspiration – This suctions out the fluid inside the cyst using a syringe or needle. Studies show that patients who undergo cyst aspiration for three times have a significantly reduced risk of recurrences.
- Finger or wrist splint, depending on the location of the ganglion cyst – By restricting the movement of the affected body part, the splint effectively reduces the accumulation of fluid inside the sac.
These initial treatment methods can also be done conjunctively. However, a ganglionectomy becomes necessary if the cyst:
- Shows signs of rapid growth
- Impairs normal body function
- Causes the patient extreme and chronic pain
The surgery is expected to remove the cyst entirely, restore the full function and original appearance of the affected body part, and relieve any associated pain.
How Does the Procedure Work?
Prior to undergoing a ganglionectomy, a patient complaining of an abnormal growth will first undergo an ultrasound or MRI (magnetic resonance imaging) scan to confirm if the growth is a ganglion cyst or another type of mass. The scans also tell the surgeon whether there are arteries, nerves, or blood vessels that are or may be affected by the treatment. If a blood vessel is likely to be affected, a general surgeon may send the patient to a hand surgery specialist. Doctors may also prescribe an x-ray, but usually only when bone-related issues are suspected.
A ganglionectomy is performed under local, regional, or general anaesthesia, depending on the unique circumstances of the patient. This will keep the patient from experiencing any pain during the surgery.
The surgery begins with the surgeon making an incision around the cyst, which allows him to remove it completely. Once the cyst is removed, the surgeon will close the incisions using stitches and place a dressing over the wound to protect it as it heals.
Nowadays, there is an alternative type of surgery to treat this condition. Known as arthroscopic surgery, this option is available only to patients with a simple case of ganglion cyst. In this type of surgery, the surgeon makes a small incision to accommodate an arthroscope, or a tube with an attached camera. This gives the surgeon a view from within the affected area. Another larger incision is then made to remove the cyst. This type of procedure shortens the healing time and, since it requires only a small cut, scarring is very minimal.
After the procedure, the patient is allowed to go home once the effects of the anaesthesia have worn off. Before getting discharged, however, he will be given instructions on how to care for the wound, what activities to avoid, what symptoms to watch out for, and when to come back for a post-surgical follow-up. During the first follow-up, which takes place 1 to 2 weeks after the procedure, the surgeon will remove the stitches.
Possible Risks and Complications
A ganglionectomy is a relatively safe surgical procedure with minimal risks involved. Most of which are commonly associated with all types of surgical procedures. These include:
- Allergic reactions to anaesthesia
- Infection – Patients are advised to seek medical attention right away if they notice pus or other drainage coming out from the wound or if the stitches feel sore, tender, and are becoming increasingly red.
- Mild pain or discomfort – This is commonly experienced by patients who receive only local or regional anesthesia.
It is also possible to experience some scarring after a ganglionectomy, but the scar usually becomes less noticeable over time.
Aside from these common risks, there are also some unique risks involved. For one, a ganglionectomy does not ensure that the cyst will not recur. Studies show, however, that there is a significant decrease in recurrence rates following the surgical excision of the cyst, as compared to the results of other less invasive treatments such as aspiration and steroids.
Additionally, there is a small risk that some nerves or blood vessels in the area will be damaged during the procedure.
- Gude, W. Curr Rev Musculoskelet Med, December 2008.