Intraosseous bone ganglia are known to be a cause of chronic wrist pain and disability. The most frequently found are the intraosseous lunate bone ganglia (ILBG). Intraosseous ganglia can occur or co-exist in other carpal bones, usually scaphoid, capitate, and triquetrum; multiple locations are not rare. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. This chapter describes an arthroscopic approach of the ILBG preserving all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the one to two portals and instrumentation through the three to four portals. The rest of the procedure is straightforward; curettage and bone grafting are performed through this specific approach, similarly to other techniques. This easy and accurate approach avoids any damage to the major cartilages of the lunate, while the reliable access to the intraosseous bone ganglion allows cyst curettage and autologous bone graft in a proper and noninvasive way.