Hyaluronidase aspiration vs surgical excision of ganglion cysts: a randomized controlled trial

Surgical treatment of a ganglion cyst is commonly performed but excision is associated with high recurrence rates. Some authors have reported alternative, less invasive treatment regimens such as aspiration using dissolving substances. The aim of this prospective randomized controlled trial was to investigate whether injecting ganglion cysts with hyaluronidase followed by aspiration was as effective as surgical excision. In one group of patients, 150 units of hyaluronidase (HD) were injected in each ganglion cyst by a 15 gauge needle followed by a 15 min equilibration period. The contents were then aspirated with constant suction by a 20 ml syringe. In the surgical group, the ganglion cyst was dissected down its neck and excised under local anesthetics. Pain sensation was evaluated by a visual analogue scale (VAS) at various time points. A total of 38 patients were enrolled in the study. However, only 32 patients were available for analysis (HD group: 20. surgery: 12). Seventeen of the 20 patients treated with HD demonstrated recurrent disease during follow-up. In contrast, following excision only 3 out of 12 patients demonstrated recurrent disease (p<0.05). Pain during motion following surgical excision was not reduced postoperatively compared to preoperative values. HD-assisted aspiration of ganglion cysts is not effective. Surgical excision is fairly successful although some degree of pain usually persists. An observation period is indicated prior to invasive treatment since a portion of ganglion cysts resolve spontaneously.