Green believes that repetitive trauma or irritation results in the increased production of hyaluronic acid which subsequently dissects through the capsule or ligament to form the capsular ducts. These ducts and lakes coalesce to form the main subcutaneous cyst. The microscopic appearance of ganglion cysts is conspicous for the absence of inflammatory cells, lack of mitotic activity and the lack of a synovial or epithelial lining of the single or multiloculated cysts. These cyst walls are composed of compressed collagen fibers and occasional flattened cells . Aspiration of the cyst followed by injection of lidocaine and steroids has proven useful in abating symptoms for variable periods of time.
Surgical treatment remains the gold standard to which all other treatments are compared.
Ganglion excision in all areas requires tourniquet control, meticulous hemostasis, excision of all mucinous pockets and careful preservation of surrounding neural structures. In ganglion cysts compressing the peroneal nerve, few recurrences have been reported following surgical excision, even in cases where complete excision was not possible because of the risk of nerve damage. Fritz, RC, et al.