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Singh R, Madasswery S, Colman M, Kent PM. Denosumab and sclerotherapy for recurrent spinal aneurysmal bone cyst in a child. BMJ Case Rep 2024; 17:e257450. [PMID: 38589235 PMCID: PMC11015305 DOI: 10.1136/bcr-2023-257450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Aneurysmal bone cyst (ABC) is a non-malignant, locally destructive, blood-filled lesion in the bone that tends to grow aggressively. A young girl presented with a rapid recurrence after aggressive surgery of a large symptomatic sacral-spinal ABC. After a multidisciplinary tumour board, she was successfully treated with sclerotherapy and monthly intravenous denosumab. The patient has maintained asymptomatic for over 36 months now and has returned to full activity and strength. She never required surgery and has had radiologic resolution of the lesions. Treatment of recurrent ABC requires a multidisciplinary team approach. We believe this to be the first report to use this combined therapy to provide an alternative to morbid surgery for children with ABCs.
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Affiliation(s)
- Raj Singh
- College of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Matt Colman
- Rush University Rush Medical College, Chicago, Illinois, USA
| | - Paul McKeegan Kent
- Medical Director, FibroFighters Foundation LLC, Temecula, California, USA
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Gragnano E, Opancina V, Muto G, Giordano F, Guarnieri G, Hirsch J, Della Gata L, Piovan E, Muto M. Treatment of Spinal Aneurysmal Bone Cyst with Percutaneous Injection of Hydroxyapatite Osteoconductive Cement. Cardiovasc Intervent Radiol 2023; 46:1726-1731. [PMID: 37978064 DOI: 10.1007/s00270-023-03606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The aim of this study was to evaluate treatment efficacy of percutaneous injection of hydroxyapatite-osteoconductive-cement in patients with spinal aneurysmal bone cysts. MATERIALS AND METHODS The study was designed as a retrospective observational clinical study. We included patients who were diagnosed with of spinal aneurysmal bone cyst, at our institution between 2013 and 2020, and treated with percutaneous injection of osteoconductive cement: "Cerament"® (BONESUPPORT AB, Lund, Sweden). Typical clinical and radiological features of the ABCs treatment and follow-up were investigated. RESULTS Our study included nine patients, two children and seven adults. Three different types of approaches were applied: (single pedicle approach in 3 patients; double pedicle approach in 2 patients; while in the remaining cases, a multiple access approach was used. VAS score decreased from 8.5 ± 0.5 before treatment to 4.1 ± 0.9 at 6-months-follow up. All of the patients reacted well to treatment, with none neurological complications, complete loss of pain and achieved osteosclerosis as radiological marker of treatment success. CONCLUSION Treatment of symptomatic spinal ABC's with hydroxyapatite cement is effective to achieve complete pain reduction and sclerosis.
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Affiliation(s)
- Eduardo Gragnano
- Faculty of Medicine, The University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Valentina Opancina
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, Naples, Italy.
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
| | - Gianluca Muto
- Service de Radiologie, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Flavio Giordano
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, Naples, Italy
| | - Gianluigi Guarnieri
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, Naples, Italy
| | - Joshua Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Luigi Della Gata
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, Naples, Italy
| | - Enrico Piovan
- U.O.C. of Neuroradiology, Department of Health Services, Carlo Poma Hospital, ASST-Mantova, Mantua, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, Naples, Italy
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Abstract
PURPOSE OF REVIEW Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature. RECENT FINDINGS In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children. SUMMARY Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.
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Wong MN, Braswell LE, Murakami JW. Doxycycline sclerotherapy of cervical spine aneurysmal bone cysts: single-institution 13-year experience. Pediatr Radiol 2022; 52:1528-1538. [PMID: 35305122 PMCID: PMC9271102 DOI: 10.1007/s00247-022-05328-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign, locally aggressive neoplasms that typically affect patients during their first two decades of life. Curettage with or without bone grafting or adjuvants is the current standard treatment; however, other surgical and medical treatments, such as sclerotherapy, have been reported. Treatment options for cervical spine ABCs are more limited because the proximity of ABCs to critical structures leads to greater risk of spontaneous or treatment-related adverse events, including death. OBJECTIVE To retrospectively review all children and young adults with cervical spine ABCs treated with doxycycline sclerotherapy at one referral center to assess its viability as a standalone treatment. MATERIALS AND METHODS We retrospectively reviewed the clinical notes and imaging of 16 patients treated with doxycycline sclerotherapy for pathologically proven cervical spine ABCs at our institution between May 2008 and March 2021. All patients underwent image-guided percutaneous doxycycline sclerotherapy to ablate the ABC and stimulate bone formation. We assessed clinical outcomes through chart review and described post-treatment imaging outcomes using modified Neer scoring. RESULTS Of the 16 total children and young adults treated, 2 were lost to follow-up, leaving 14 patients with a median age of 14.5 years. Twelve of these 14 patients were successfully treated with doxycycline sclerotherapy for a success rate of 86%. One patient experienced one treatment-related complication (Society of Interventional Radiology [SIR] adverse event classification D), before ultimately being successfully treated. Doxycycline treatment failed in two patients, who then underwent surgical management. Post-treatment imaging of successfully treated cases had a mean modified Neer score of 1.3, whereas post-treatment imaging in failed cases had a mean score of 3.5. CONCLUSION Doxycycline sclerotherapy is a viable standalone treatment for cervical spine ABCs because it is safe and effective while avoiding the morbidity associated with open surgical treatments.
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Affiliation(s)
- Megan N Wong
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Leah E Braswell
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - James W Murakami
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Ríos-Méndez RE, Espin-Villamarin LG, Rovalino-Troya CJ, Rosero-Lema VF, Barona-Freire EB, Reinoso-Recalde DI. [Andean children with aneurysmal bone cyst treated with polidocanol (use off-label)]. Acta Ortop Mex 2021; 35:529-533. [PMID: 35793253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The aneurysmal bone cyst is a rare benign but aggressive osteolytic tumor for which there is still no ideal treatment, the reports on treatment by sclerotherapy in the pediatric population are scarce and in our region even less. The objective is to communicate the experience of the treatment of aneurysmal bone cyst with polydocanol 3%. MATERIAL Y METHODS Retrospective, descriptive and cross-sectional study. Period: June/2017 to June/2021. Inclusion: patients with histological diagnosis of aneurysmal bone cyst; Under general anesthesia and fluoroscopic guidance, intralesional puncture with 16G needle was performed through which 3% polydocanol was slowly administered. Data: medical history. Quantitative variables shall be expressed in measures of central tendency and dispersion; qualitative variables shall be expressed as frequencies or percentages. RESULTS Nine consecutive patients were included, all of whom had pain and tumor in one of the extremities. Gender: 3 female and 6 male. Age: median 10.5 years (range: 2-15.1). Weight: median 32.8 kg (range: 11-44.5). Total procedures: 44; procedures per patient: mean 4.9 (SD: ± 2.0). Procedure time: mean 33.9 minutes (SD: ± 18.3); radiation: mean 1.34 mGy (SD: ± 1.55). Hospitalization: one day, except one patient. Complications: skin damage in one case, no recurrences follow-up: 12 to 50 months. CONCLUSION In this pediatric series, polydocanol 3% was useful and effective for the treatment of aneurysmal bone cyst, with few complications. One disadvantage is that it requires several sessions and in addition, no significant difference has been demonstrated between other forms of treatment in terms of the recurrence rate.
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Cruz GS, Cuevas-Suárez CE, Saavedra JPA, Giorgis R, Teixeira MRK, Muniz FWMG. Percutaneous treatments of primary aneurysmal bone cysts: systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2021; 31:1287-1295. [PMID: 33550464 DOI: 10.1007/s00590-021-02893-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To systematically review the literature to determine recurrence rates of percutaneous treatments for primary aneurysmal bone cysts (ABC). METHODS Search strategies were performed in the following databases: PubMed, SCIELO, LILACS and BVS, using terms in English, Spanish and Portuguese (PROSPERO Registration Number: CRD42020170340). Longitudinal studies, either observational or clinical trials, with at least five patients and with a mean of 18 months of follow-up were included. Studies had to use any type of percutaneous treatments and report the recurrence rates of primary ABC treatment. Studies selection, data extraction and risk of bias assessment were performed independently by two researchers. A global meta-analysis was carried out to assess the proportion of recurrence. Studies were categorized into two subgroups: selective arterial embolization and sclerotherapy. RESULTS Thirteen studies were included in the present study. The average success rate of percutaneous treatments for ABC was 91.11%, with a total of 37 lesions recurrences in the 416 patients. The sex ratio was 1:1. The subgroup of sclerotherapies presented a lower proportion of recurrence. The proportion of recurrence in the subgroup of selective arterial embolization was 19% (95%IC 12.11-27.54) and that of sclerotherapies was 6% (95%IC 3.65-9.19). CONCLUSIONS Both percutaneous treatments for ABC are effective, showing a lower rate of recurrence. Sclerotherapy treatments seem to be promising, but further clinical trials must be conducted with a longer follow-up.
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Muratori F, Mondanelli N, Rizzo AR, Beltrami G, Giannotti S, Capanna R, Campanacci DA. Aneurysmal Bone Cyst: A Review of Management. Surg Technol Int 2019; 35:325-335. [PMID: 31476792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aneurysmal bone cyst is a rare lesion that is most often found in young adults and children. It can have an unpredictable behavior, with a high recurrence rate after treatment. Treatment is based on personal and institutional experience and preferences. Standard treatment consists of curettage (manual + motorized high-speed burr) plus local adjuvants and bone grafting to fill the void. In anatomical locations that are difficult to reach surgically, percutaneous procedures (injection of sclerosant agents, radiofrequency thermal ablation (RFTA)) or selective arterial embolization (SAE) are used. Medical management with bisphosphonates (BPs) or denosumab has also been advocated. Minimally invasive surgical procedures such as "curopsy" and percutaneous demineralized bone matrix (DBM) and/or autologous bone marrow concentrate (BMC) grafting have also been proposed. SAE is used as a pre-operative procedure to reduce intra-operative bleeding in the case of large lesions and as primary treatment for spinal lesions. The purpose of this review is to present currently available options for the management of aneurysmal bone cyst.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Nicola Mondanelli
- Department of Orthopedics and Traumatology, University of Siena, Siena, Italy, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Anna Rosa Rizzo
- Department of Orthopaedic Oncology and Reconstructive Surgery Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Stefano Giannotti
- Department of Orthopedics and Traumatology, University of Siena, Siena, Italy, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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Abstract
RATIONALE Primary malignancy in giant cell tumor of bone (PMGCTB) is extremely unusual. PMGCTB in the thoracic vertebrae is particularly rare. PATIENTS CONCERNS A 23-year-old man was admitted with a chief complaint of chest pain associated with cough for approximately 3 days. Physical examination revealed a palpable, immobile, tender, 7 cm mass in the right paravertebral area of the thoracolumbar spine. DIAGNOSIS Computed tomography images revealed an osteolytic, expansive, and eccentric lesion on the vertebral bodies and right accessory processes with spinal cord compression in the thoracic vertebra, with right rib also having bone destruction. Magnetic resonance imaging revealed multiple fluid-fluid levels occupying more than one-third of the lesions. On the basis of the imaging and pathological findings, the final pathological diagnosis was PMGCTB with aneurysmal bone cyst. INTERVENTIONS The patient underwent successful wide spondylectomy of T9/10 to remove the tumor, and adjuvant chemotherapy based on the protocol used for osteosarcoma. OUTCOMES After 4 years of follow-up, there is no clinical or radiological evidence of recurrence. LESSONS PMGCTB is difficult to distinguish from giant cell tumor of bone. PMGCTB should be considered when lesions appear with multiple fluid-fluid levels and soft tissue mass.
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Rapp M, Grauel F, Wessel LM, Illing P, Kaiser MM. Treatment outcome in 60 children with pathological fractures of the humerus caused by juvenile or aneurysmal bone cysts. Acta Orthop Belg 2016; 82:723-729. [PMID: 29182112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The treatment of pathological fractures of the humerus caused by juvenile or aneurysmal bone cysts (JBC/ABC) should be a single approach with a high success rate and low complication rate. This study evaluates how day by day treatment concepts fulfil these aims. Children below 15 years of age with a pathological fracture of the humerus caused by a JBC or ABC between 01.01.2001 and 31.12.2010, were investigated by chart review in four major paediatric trauma centres. Age, gender, fracture localisation, X-ray findings, treatment and outcome - assessed by the Capanna classification (I to IV), were analysed. 60 children [41male, 19 female; mean age: 9 years (4-14 years)] with 43 JBC and 12 ABC were included as well as five cysts, who could not be classified definitively. First treatment was non-operatively in 33 children. Of these 27 cysts did not improve; likewise the supportive installation of cortisone in six patients did not change the outcome. The first treatment consisted of elastic stable intramedullary in 13 children; up to three nail exchanges included. But only six of these reached (nearly) complete resolution (I/II). Overall the combined mechanical and biological treatment with curettage, elastic stable intramedullary nailing, (artificial) bone substitute and in some cases growth factors was performed as the 1st-line treatment in nine patients and further in 2nd or 3rd-line treatments in 13 humeral cysts. More than half of these reached a complete or nearly complete resolution of the cyst (12x I, 5x II, 1x III, 4x IV). Major complications in all operated patients were six nails not removable and two children with upper extremities length differences. Healing rates are low for non-operative treatment, elastic stable intramedullary nailing alone and by using cortisone for cysts resolution in pathological fractures of the humerus. Data support a combined mechanical and biological treatment with curettage, elastic stable intramedullary nailing, (artificial) bone substitute and the use of growth factors.
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Hauschild O, Lüdemann M, Engelhardt M, Baumhoer D, Baumann T, Elger T, Südkamp NP, Herget GW. Aneurysmal bone cyst (ABC) : treatment options and proposal of a follow-up regime. Acta Orthop Belg 2016; 82:474-483. [PMID: 29119887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to describe treatment -options and develop a follow-up regime for the -aneurysmal bone cyst, a neoplastic bone lesion with a noticeable recurrence rate. Reports of 28 patients and a mean follow-up of 42.2 months treated multidisciplinary were analysed. Data were complemented by a literature review including 790 patients. Patient age was from seven to 57 years, in line with the literature (1-69 years). Lesions most frequently affect long bones, spine and pelvis ; pain is the most common symptom. Treatment modalities vary, recurrences -occurred in 26.1% in our series, rates ranged from 0-60% in the literature, with the vast majority within 2 years. With regard to the findings we propose, irrespective of treatment, a follow-up regime including clinical survey and imaging, best with MRI, at 3 months, 6 months and at half-yearly intervals within the first two and yearly within the third to fifth year.
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Soares do Brito J, Portela J. [Selective Arterial Embolization for a Large Pelvic Aneurysmal Bone Cyst Treatment]. ACTA MEDICA PORT 2015; 28:780-783. [PMID: 26849765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Abstract
Aneurysmal bone cysts are benign musculoskeletal tumours, which occur in young patients and, occasionally, with aggressive behaviour. Those tumours very often will need surgical treatment with curettage and bone grafting, but for aggressive lesions, inbloc resection is more advisable. Aggressive tumours use to be large and sometimes with difficult surgical approach and demanding complex surgical reconstructions. In this scenario, selective arterial embolization is a possible primary or adjuvant treatment option. This paper presents a paradigmatic case, where selective arterial embolization allowed a successful treatment of a large aneurysmal bone cyst with difficult surgical resolution.
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Affiliation(s)
- Joaquim Soares do Brito
- Serviço de Ortopedia e Traumatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - José Portela
- Serviço de Ortopedia e Traumatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
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Mavrogenis AF, Angelini A, Rossi G, Rimondi E, Guerra G, Ruggieri P. Successful NBCA embolization of a T2 aneurysmal bone cyst. Acta Orthop Belg 2014; 80:126-131. [PMID: 24873097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surgically accessible aneurysmal bone cysts (ABC) have traditionally been treated with curettage. Selective arterial embolization was initially proposed as a preoperative adjuvant to reduce peroperative bleeding. Currently, the role of embolization has been extended to the definitive treatment of aneurysmal bone cyst of the spine in children, as well as to other locations in the skeleton. The authors describe the technique in a 15-year-old girl with a T2 aneurysmal bone cyst. Digital subtraction angiography was performed for tumor vascular mapping, followed by selective arterial embolization with N-butyl 2 cyanoacrylate (NBCA). Because of persistent local pain, repeat embolization was done at 8 months. Pain relief and progressive ossification of the lesion were now observed. At 4-year follow-up, the patient was asymptomatic, with complete ossification of the lesion. Selective arterial embolization (SAE) is a minimally invasive, safe and effective procedure for the permanent occlusion of the pathological feeding vessels of spinal ABC. It should be considered as the treatment of choice for lesions difficult to access with surgery, especially in young patients. Careful pre-embolization vascular mapping of the lesion, operator's experience and use of NBCA are the keys to success.
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Wang C, Liu X, Jiang L, Yang S, Wei F, Wu F, Liu Z. Treatments for primary aneurysmal bone cysts of the cervical spine: experience of 14 cases. Chin Med J (Engl) 2014; 127:4082-4086. [PMID: 25430453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is a benign lesion with the potential to be locally aggressive. The optimal treatment of cervical spine lesions remains controversial. This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine. METHODS This series included eight men and six women diagnosed between 2002 and 2012. A retrospective review of the hospital charts, operating room reports, office charts, and radiographs was performed. The data collected included patient age, sex, radiological features, pathology, treatment methods, outcomes, and complications from biopsies and treatments. The mean age at diagnosis was 17.5 years old with a range of 6-35 years. All patients had experienced local pain for a mean of 7.3 months (range, 0.5-18.0 months), and three patients had neurological deficits (one with radiculopathy and two with myelopathy). The Frankel classification before treatment was E in 12 cases, D in one case, and C in one case. RESULTS Four patients received radiotherapy alone. Ten patients underwent surgery, including five total spondylectomies, two local resections, and three curettages. Three patients received preoperative selective arterial embolization, and four received adjuvant radiotherapy. The mean follow-up time was 44.5 months (range 12-96 months), and no recurrence was identified. Three patients with neurological deficits achieved complete recovery, as noted at the final follow-up examination. One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy. He refused further treatment. CONCLUSIONS The results can be achieved by different treatments (surgical resection/curettage, selective arterial embolization, and radiotherapy) for ABC of the cervical spine. Reconstruction of stability is also important for the treatment of cervical ABC.
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Affiliation(s)
- Chao Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Shaomin Yang
- Department of Pathology, Peking University Health Science Center, Beijing 100191, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China.
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Cheng Z, Peng X, He W. Arterial embolization of primary sacral aneurysmal bone cyst. Chin Med J (Engl) 2014; 127:1785-1787. [PMID: 24791892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Zhiyuan Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiaoxin Peng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Colangeli S, Rossi G, Ghermandi R, Rimondi E. Fluid-fluid levels detected on MRI and mimicking primary aneurismal bone cysts in a case of spinal bone metastasis. Eur Rev Med Pharmacol Sci 2014; 18:41-43. [PMID: 24825040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Spinal bone metastases may be lytic or sclerotic lesions. Sometimes aneurismal bone cyst (ABC)-like areas (also called "secondary ABC") can be found in giant-cell tumors, osteoblastomas and chondroblastomas but are rare in metastatic tumors. CASE REPORT A retrospective study on 518 patients surgically treated for metastatic lesions of the spine from 1995 to 2012 was performed to evaluate the radiographic presentation. We propose a case report of a metastatic lesion associated with imaging features suggestive of aneurismal bone cyst. The patient was treated by intralesional surgery, after embolization of the lesion. CONCLUSIONS Fluid-fluid levels detected on imaging can be found in bone metastases and may be similar to a primary aneurismal bone cyst. Embolization of metastastic tumor was useful to help the surgeon.
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Affiliation(s)
- S Colangeli
- Department of Oncological and Degenerative Spine Surgery, Rizzoli Orthopedic Institute, Bologna, Italy.
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Cosío-Lima L, Cosío Pascal M, Monges-Nicolau A. [Aneurysmatic cyst of the manubrium sterni: case report and literature review]. Acta Ortop Mex 2009; 23:306-310. [PMID: 20336883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report the case of a 62-year-old patient with an aneurysmatic manubrium sterni cyst. According to the literature reviewed, this is an extremely rare case. The patient was referred to the cardiothoracic surgery service by physicians of a remote rural clinic, with a diagnosis of ascending aortic aneurysm of probable luetic etiology. The aortography and the lab (VDRL) ruled out this possibility. Two biopsy punctures were needed to find the histologic elements that could guide the final diagnosis. The medical-surgical committee decided to refer the patient to oncology for first-line radiation therapy. As a result of treatment, by week 4 the lesion had decreased 75-80% in size and was not throbbing any more. The patient had a slightly irregular residual mass, with a fibrous consistence but not painful nor limiting of function. The case was followed-up every three months for two years. By the end of this period no change nor sign of lesion recurrence were reported. According to the literature reviewed, this is the second case reported in this location.
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Tomasik P, Spindel J, Miszczyk L, Chrobok A, Koczy B, Widuchowski J, Mrozek T, Matysiakiewicz J, Pilecki B. Treatment and differential diagnosis of aneurysmal bone cyst based on our own experience. Ortop Traumatol Rehabil 2009; 11:467-475. [PMID: 19920289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Aneurysmal bone cyst was first described by Jaffe and Lichtenstein in 1942. Schajowicz in 1972 in his Histopathological Classification of Primary Bone Tumors (later modified by WHO in 1993) placed it in group IX - tumor-like lesions. Its etiology and pathogenesis is not completely clear. Aneurysmal bone cysts are usually found in older children and young adults, rarely before the age of 5 or after 30. The aim of the study is to evaluate aneurysmal cyst treatment outcomes in patients we have treated and present diagnostic difficulties, especially considering the giant cell tumor in differential diagnosis. MATERIAL AND METHODS The study group consisted of 40 patients aged from 10 to 65 years (mean age 22 years), including 21 men and 19 women, who underwent surgery at the Bone Tumor and Neoplasm Unit between 1999 and 2006. The follow-up period varied from 2 to 78 months (mean 23 months). RESULTS A single surgical procedure was performed in 25 patients. No recurrences were noted in this group. In the remaining 15 cases, the tumor relapsed between 2 and 72 months after surgery (mean 17 months). In 12 patients, the histopathological examination was inconclusive. The giant cell tumor of bone was considered as a second diagnosis in all these cases. CONCLUSIONS 1. Surgical treatment of aneurysmal bone cysts enables radical excision of the lesion with same-time histopathological verification. 2. The basis of effective treatment of primary and recurring aneurysmal bone cysts consists in complete resection of all tissues lining the cyst and any of its components from the surrounding soft tissues. 3. An effective plan of surgical treatment of aneurysmal bone cyst aimed at reducing the risk of tumor recurrence relies crucially on precise determination of its size, characteristics and topography via imaging workup. 4. Relapses are most common in patients suffering from the aggressive or active form of aneurysmal bone cyst. 5. Tumor location in direct proximity of a joint and the presence of epiphyseal cartilage hinders complete resection of the lesion and gives rise to technical problems during surgery. 6. The diagnosis of aneurysmal bone cyst most often leads physicians to assume the presence of giant cell tumor. If this diagnosis is confirmed following surgery, the patient should be subjected to additional radiotherapy. 7. Patients suffering from aneurysmal bone cyst require a ling follow-up due to the possibility of late recurrence of the tumor.
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Affiliation(s)
- Patryk Tomasik
- Dr J. Daab Regional Hospital of Trauma Surgery, Piekary Slaskie, Poland.
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18
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Lindfors NC. Treatment of a recurrent aneurysmal bone cyst with bioactive glass in a child allows for good bone remodelling and growth. Bone 2009; 45:398-400. [PMID: 19379850 DOI: 10.1016/j.bone.2009.04.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 03/31/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
A recurrent aneurysmal bone cyst of the proximal phalanx of the index finger of a three-year-old child, treated with bioactive glass, is presented. Over a two-year follow-up, the treated area appeared dense on X-rays. At two years, no cavity was observed and the homogenous region resembled normal trabecular bone. The phalanx had grown in length and remodelled to an almost normal shape.
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19
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Kontakis GM, Karantanas AH, Papagelopoulos PJ. Orthopaedic . Radiology . Pathology Conference: painful ulnar lesion in a 16-year-old boy. Clin Orthop Relat Res 2009; 467:861-6. [PMID: 18813891 PMCID: PMC2635456 DOI: 10.1007/s11999-008-0510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/27/2008] [Indexed: 01/31/2023]
Affiliation(s)
- George M Kontakis
- Department of Orthopaedics, University of Crete, Heraklion, Crete, Greece.
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20
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Yildirim E, Ersözlü S, Kirbaş I, Ozgür AF, Akkaya T, Karadeli E. Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagn Interv Radiol 2007; 13:49-52. [PMID: 17354197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Treatment options of aneurysmal bone cysts include complete resection, curettage, curettage with bone grafting, selective arterial embolization (as a primary treatment or preoperative adjuvant therapy), and percutaneous injection of fibrosing agent. Treatment in pelvic locations is difficult because of the relative inaccessibility of the lesions, the proximity of the lesions to neurovascular structures, and the vulnerability of the acetabulum. Herein, we present 2 pediatric cases of pelvic aneurysmal bone cysts successfully treated with curettage with bone grafting following preoperative selective arterial embolization.
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Affiliation(s)
- Erkan Yildirim
- Department of Radiology, Başkent University School of Medicine, Konya, Turkey.
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21
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Abstract
INTRODUCTION Despite the long experience of radiologists, pathologists and orthopaedists with aneurysmal bone cysts (ABC), there is limited knowledge regarding the cause of the lesion and the optimal treatment. The pathogenesis of ABC remains unclear with theories ranging from a post-traumatic, reactive vascular malformation to genetically predisposed bone tumours. Recent genetic and immunohistochemical studies proposed that primary ABC is a tumour and not a reactive tumour-simulating lesion. The chromosomal analyses and some reported familial cases of this osteolytic bone lesion propose a hereditary factor in a presumably multifactorial pathogenesis. MATERIALS AND METHODS The imaging studies, even CT scan and MRI sometimes do not provide clearly diagnostic criteria for the diagnosis of ABC. The radiographically differential diagnosis between ABC and unicameral bone cyst (UBC) is sometimes not clear. Double density fluid level, septation, low signal on T1 images and high intensity on T2 images strongly suggest the bone cyst is an ABC, rather than a UBC. CONCLUSION Common methods of treatment vary considerably in the literature. The usual methods of treatment are curettage, resection, intracystic injections and embolization. Biopsy is imperative before any treatment. Ethibloc treatment remains highly controversial. For some authors Ethibloc injection can be recommended as the first-choice treatment excluding spinal lesions. A minimally invasive method by introduction of demineralized bone and autogenous bone marrow is able to promote the self-healing of a primary ABC.
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Affiliation(s)
- Jérôme Cottalorda
- Orthopaedic Pediatric Surgery Department, University of Medicine, Saint-Etienne, France.
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22
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Abstract
The etiology of aneurysmal bone cyst is probably multifactorial. Recent progress in genetics and immunohistochemistry tends to prove that aneurysmal bone cyst is tumor and not a pseudo-tumor. Involvement of chromosomes 17p11-13 or 16q22 has been described. MRI is indispensable. Signs highly suggestive of aneurysmal bone cyst are: well-limited expansive bone lesion, low intensity T1 signal associated with high intensity T2 signal (liquid component), a low intensity peripheral line with enhancement after contrast injection, septal partitioning and fluid levels. Gadolinium injection is informative since it demonstrates the thick regular septal partitioning and the amorphous contents (lack of contrast uptake), a structure which is not seen in any other tumors, particularly malignant tumors. Plain x-ray and MRI contribute well to diagnosis but histological confirmation is always required. The debate on Ethibloc(R) remains open. For certain authors, this technique is an effective safe treatment which can be proposed as a first-line option. Ethibloc(R) should however be reserved for specialized teams because of the serious complications reported in the literature. A new treatment has also been reported to be promising, but further results will be required for confirmation. With this technique demineralized allogenic bone particles associated with autologous bone marrow are implanted in the cyst to achieve an osteogenic effect. This induces the cyst to pass from the destructive resorption phase to the repairing osteogenic phase. Curettage is not necessary. This method, which avoids extensive surgery and blood loss, is well adapted to difficult localizations such as the pelvis.
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Affiliation(s)
- J Cottalorda
- Service de Chirurgie Pédiatrique, Hôpital Nord, 42055 Saint-Etienne Cedex 2.
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23
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Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up. ACTA ACUST UNITED AC 2006; 88:1212-6. [PMID: 16943475 DOI: 10.1302/0301-620x.88b9.17829] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.
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Affiliation(s)
- S Rastogi
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India.
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24
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Abstract
The management of aneurysmal bone cyst depends on the age of the patient, the location, extent, aggressiveness and the size of the lesion. In the light of their experience and a review of the literature of 1256 aneurysmal bone cysts, the authors analyzed various treatment modalities. Inactive lesions can heal with biopsy or curettage alone. In active or aggressive lesions, elective treatment usually consists of curettage, whether associated or not with bone grafting and local adjuvants. Aneurysmal bone cyst in young children do not seem more aggressive than in older children. In pelvic locations, the emergence of a few cases of spontaneous healing (even in active or aggressive lesions) encourages the adoption of clinical and radiological supervision for some months after biopsy when possible. In some cases, the localization and extent of the cyst are such that operative treatment is extremely hazardous. Selective arterial embolization has made a considerable contribution towards the therapeutic solution of such cases. For some authors, direct percutaneous Ethibloc injection can be recommended as the first-choice treatment except in spinal lesions. Nevertheless, the complications encountered in some series after percutaneous embolization of aneurysmal bone cyst with Ethibloc should encourage the use of Ethibloc injection not as an initial treatment but as a reliable alternative to surgery.
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Affiliation(s)
- Jérôme Cottalorda
- Orthopaedics Pediatric Surgery Department, University of Medicine, Saint-Etienne, France.
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25
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Abstract
Aneurysmal bone cysts are unique pathologic entities that cause pain and local osseous destruction. Many surgical treatment modalities have been described. This article reports on the case of a 16-year-old high school athlete with left heel pain due to an aneurysmal bone cyst in the calcaneus. Curettage of the bone cyst was performed, and the void was filled with a commercially available mixture of cancellous bone and demineralized bone matrix. Early return to athletic activity was achieved, with no recurrence noted at 3-year follow-up.
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Affiliation(s)
- Brian Carpenter
- Department of Orthopaedics, Podiatry Section, John Peter Smith Hospital, Fort Worth, TX 76104, USA
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26
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Cottalorda J, Chotel F, Kohler R, de Gauzy JS, Louahem D, Lefort G, Dimeglio A, Bourelle S. Aneurysmal bone cysts of the pelvis in children: a multicenter study and literature review. J Pediatr Orthop 2005; 25:471-5. [PMID: 15958897 DOI: 10.1097/01.bpo.0000158002.30800.8f] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors analyzed a series of 15 pelvic aneurysmal bone cysts (9 boys and 6 girls) in children and adolescents who were reviewed with an average follow-up of 50.3 months. Pain and limp were the main symptoms. Four patients had no treatment after the open biopsy. Eleven patients were treated with curettage. Preoperative selective arterial embolization was performed in three cases before curettage. Two recurrences were noted after curettage; recurrences were treated successfully with further curettage. As a result, the authors recommend curettage; more aggressive operative intervention does not appear to be indicated. No major intraoperative vascular complications occurred. Spontaneous healing in a few cases (even in active or aggressive lesions) argues for clinical and radiologic observation after biopsy when possible. In case of a propitious evolution, observation must be continued and surgery might be avoided, but if the lesion increases, treatment must be proposed.
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Affiliation(s)
- Jérôme Cottalorda
- Pediatric Surgery Department, North Hospital, Saint-Etienne, France.
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27
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28
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Turowski B, Schellhammer F, Herdmann J, Rommel F. Fatal Ethibloc embolization of vertebrobasilar system following percutaneous injection into aneurysmal bone cyst of the second cervical vertebra. AJNR Am J Neuroradiol 2005; 26:1883-4. [PMID: 16091552 PMCID: PMC7975139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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29
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Cottalorda J, Kohler R, Chotel F, de Gauzy JS, Lefort G, Louahem D, Bourelle S, Diméglio A. Recurrence of aneurysmal bone cysts in young children: a multicentre study. J Pediatr Orthop B 2005; 14:212-8. [PMID: 15812295 DOI: 10.1097/01202412-200505000-00014] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Some authors have reported that the clinical and pathologic behaviour of aneurysmal bone cysts (ABCs) is more aggressive in younger patients and that younger patients have more tumour recurrence. The authors carried out a retrospective, multicentred paediatric population-based analysis of 21 patients (14 boys and seven girls), 5 years of age or younger, with primary ABCs. Only patients with a minimum follow-up of 2 years were included. The most common operation was curettage (14 cases). Methylprednisolone acetate injection was used in two cases (failure in the initial diagnosis before biopsy) with negative results. An Ethibloc (Ethnor Laboratories/Ethicon, Norderstedt, Germany) injection was employed in four cases. There were five recurrences. Three lesions recurred once, one lesion recurred three times and one recurred six times. These recurrences occurred in two cases after methylprednisolone acetate injection, after Ethibloc (Ethnor Laboratories/Ethicon) injection (one case) and, after curettage (two cases). ABCs in children, 5 years of age or younger, do not seem to be more aggressive than in older children. Curettage is a surgical procedure that can be used even in young children. Of course, recurrence is always possible but the recurrence rate is not unacceptable. More aggressive operative intervention does not appear to be indicated.
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Affiliation(s)
- Jérôme Cottalorda
- Department of Orthopaedic Paediatric Surgery, University of Medicine, Saint-Etienne, France.
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30
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Mohit AA, Eskridge J, Ellenbogen R, Shaffrey CI. Aneurysmal Bone Cyst of the Atlas: Successful Treatment through Selective Arterial Embolization: Case Report. Neurosurgery 2004; 55:982. [PMID: 15934182 DOI: 10.1227/01.neu.0000137279.58768.7e] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Aneurysmal bone cysts (ABCs) are benign and expansile osteolytic lesions that can occur in any location in the spine, including the craniovertebral junction. Aggressive resection followed by bone grafting has been the mainstay of treatment, with selective arterial embolization as a presurgical adjunct. Complete excision of these lesions at the craniovertebral junction is associated with high surgical morbidity. We report a case of successful treatment of an ABC of the atlas in a child with selective arterial embolization alone.
CLINICAL PRESENTATION:
A 10-year-old girl presented with persistent neck pain after a snowboarding accident. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansile cystic mass involving the right lateral mass of C1. Digital subtraction angiography revealed a tumor blush, which, along with the cystic appearance of the lesion, was consistent with an ABC.
INTERVENTION:
The arterial feeders to the lesion were selectively embolized with polyvinyl alcohol particles. Three sessions of embolization were required to eradicate the blood supply to the lesion completely.
CONCLUSION:
Complete surgical resection of ABCs at the craniovertebral junction can be associated with high morbidity secondary to the highly vascular and destructive nature of these lesions. The case discussed here demonstrates the viability of selective arterial embolization as a primary and stand-alone modality of treatment.
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Affiliation(s)
- A Alex Mohit
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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31
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Abstract
STUDY DESIGN A case of the solid variant of aneurysmal bone cyst affecting the posterior component of the fourth cervical vertebra is reported. Imaging studies showed an expansile destructive lesion. After curettage, autologous iliac bone grafting with posterior fusion was performed. There was no sign of local recurrence 2 years after surgery. OBJECTIVES To emphasize the occurrence of the solid variant of aneurysmal bone cyst in the cervical spine. SUMMARY OF BACKGROUND DATA The solid variant of aneurysmal bone cyst is rare, and only 12 cases occurring in the vertebrae, including 3 in the cervical vertebrae, have been reported. The condition is difficult to diagnose radiologically before biopsy or surgery. METHODS A 9-year-old girl presented with pain in the nape of the neck without any neurologic deficit. She was found to have the solid variant of aneurysmal bone cyst in the posterior component of the fourth cervical vertebra, which had destroyed the lamina and spinous process. Part of the posterior aspect of the C4 vertebral body was also involved. Curettage of the lesion was performed, and the defect in the posterior component of the vertebra was reconstructed using an autologous iliac bone graft with posterior fusion using a halo vest. RESULTS Magnetic resonance imaging disclosed a homogeneous low intensity mass at the lamina, spinous process, and vertebral body of C4 on T1-weighted images. The mass showed heterogeneous high signal intensity on Gd-enhanced images. Histologically, the resected specimen showed predominant fibroblastic proliferation, with minor foci of reactive osteoid formation and an area of osteoclast-like giant cells. Neither cellular atypia nor mitotic figures were evident. There was no sign of local recurrence 2 years after surgery. CONCLUSIONS The solid variant of aneurysmal bone cyst should be included in the differential diagnosis of any lytic expansile lesion of the spine, even though it is a destructive lesion. Gd-enhanced magnetic resonance imaging may be helpful for distinguishing the solid variant from conventional aneurysmal bone cyst.
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Affiliation(s)
- Michihiro Suzuki
- Department of Orthopedic Surgery, School of Medicine, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan
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32
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Abstract
PURPOSE To report complications of direct fibrosing agent injection in the treatment of aneurysmal bone cysts (ABCs) in children. MATERIALS AND METHODS The authors retrospectively analyzed all cases of ABCs treated with direct fibrosing agent injection (Ethibloc; Ethnor Laboratories, Ethicon, Noderstedt, Germany) at Robert Debré Hospital since 1994. Histologic diagnosis was assigned by means of surgical biopsy findings prior to treatment. Treatment responses were categorized. Injection was administered with general anesthesia, computed tomographic guidance, and use of a 14- to 16-gauge needle. Contrast material was injected to determine presence of intracystic septa and verify absence of venous opacification. Amount of fibrosing agent injected corresponded to amount of contrast material necessary to fully opacify the cyst. Intraosseous needle track was obliterated with histoacryl injection. RESULTS Fifteen patients were treated. Mean follow-up was 80 months; no patient was lost to follow-up. One patient experienced pulmonary embolus that necessitated a 7-day intensive care unit stay. Four patients experienced early aseptic fistulization after the first injection, which led to surgical débridement and curettage. Five patients had transient inflammatory reaction with mild 38 degrees C fever, which was controlled with analgesic and antiinflammatory drugs. Eleven patients did not require surgery, and results at latest follow-up were considered to indicate complete healing (type 1 results) in nine and incomplete healing (type 2 results) in two. For type 1 results: Six patients received one injection, two received two injections, and one received three injections. For type 2 results: one patient received one injection, and one received three injections. CONCLUSION A high rate of major local and general complications was encountered with use of direct fibrosing agent injection; the technique has been abandoned for treatment of ABCs.
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Affiliation(s)
- Vicken Topouchian
- Department of Orthopedic Surgery, Robert Debré Hospital, 48 bd Sérurier, 75019 Paris, France.
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Abstract
An eighteen month old female Doberman pinscher dog was referred to teaching hospital of Adnan Menderes University, Faculty of Veterinary Medicine with the complaint of right forelimb lameness for a month. On the basis of clinical, radiographical, scintigraphical, computed tomographical and histopathological findings, aneurysmal bone cyst was diagnosed. Surgical curettage and bone cement treatment were applied. The patient recovered after 12 months. This case proves that aneurysmal bone cyst, without osteolysis and/or damages to the surrounding tissues, may result in a good prognosis if curettage and treatment with bone cement are done.
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Affiliation(s)
- Murat Sarierler
- Department of Surgery, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey
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34
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Liu JK, Brockmeyer DL, Dailey AT, Schmidt MH. Surgical management of aneurysmal bone cysts of the spine. Neurosurg Focus 2003; 15:E4. [PMID: 15323461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECT Aneurysmal bone cysts of the spine are benign, highly vascular osseous lesions of unknown origin that may present difficult diagnostic and therapeutic challenges. They are expansile lesions containing thin-walled, blood-filled cystic cavities that cause bone destruction and sometimes spinal deformity and neurological compromise. The treatment of aneurysmal bone cysts of the spine remains controversial according to the literature. In this review, the authors discuss the clinical manifestations, pathophysiological features, neuroimaging characteristics, and treatment strategies for these lesions. METHODS Treatment options include simple curettage with bone grafting, complete excision, embolization, and radiation therapy. Reconstruction and stabilization of the spine may be warranted if deformity and instability are present. Special factors need to be considered in the management of these lesions. CONCLUSIONS Complete excision of aneurysmal bone cysts offers the best chance of cure and spinal decompression if neurological deficits are present.
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Affiliation(s)
- James K Liu
- Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, Utah 84132, USA
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35
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Wathiong J, Brys P, Samson I, Maleux G. Selective arterial embolization in the treatment of an aneurysmal bone cyst of the pelvis. JBR-BTR 2003; 86:325-8. [PMID: 14748394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
This case report deals with an aggressive aneurysmal bone cyst of the pelvis in a 20-year-old man causing considerable destruction of the left ilium and the anterior column of the acetabulum, with extension into the pelvis. The treatment of large pelvic aneurysmal bone cysts is challenging because of local destruction of adjacent structures and because of the risk of severe intraoperative bleeding. Therefore selective preoperative embolization may be a valuable tool in the management of aneurysmal bone cysts.
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Affiliation(s)
- J Wathiong
- Department of Radiology, University Hospitals, Leuven, Belgium
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36
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Abstract
The management of sacral tumors is challenging because of difficulties in accessing the lesion, the high rate of local recurrence, extensive vascularity causing significant intraoperative blood loss, resistance to radiation therapy, and risk of malignant transformation. Although surgery is the main treatment for many sacral tumors, embolization is a valuable primary and adjunctive therapy. Patients with benign lesions, including aneurysmal bone cysts and giant cell tumors, have responded to embolization with resolution of their symptoms and with ossification of their lesions. Embolization is used as a primary therapy for metastatic lesions and results in neurological improvement, reduced tumor size, and decreased spinal canal compromise. It is also used as an adjuvant therapy to reduce intraoperative blood loss and to aid in the resection of benign, malignant, and metastatic sacral lesions. It is important to note that embolization techniques are a valuable resource in the treatment of sacral tumors, and, overall, embolization should always be considered in patients with sacral tumors.
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Affiliation(s)
- Oren N Gottfried
- Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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37
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Pogoda P, Linhart W, Priemel M, Rueger JM, Amling M. Aneurysmal bone cysts of the sacrum. Clinical report and review of the literature. Arch Orthop Trauma Surg 2003; 123:247-51. [PMID: 12692673 DOI: 10.1007/s00402-003-0496-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2002] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aneurysmal bone cysts, first described by Jaffe and Lichtenstein in 1942, are benign lesions that may easily be mistaken for a malignant tumor both radiographically and pathologically. These diagnostic problems are due to their rapid growth, extensive destruction of bone, wide extraosseous tumor masses, and marked cellular exuberance. The differential diagnosis of aneurysmal bone cysts including giant cell tumor, calcified solitary bone cysts, low-grade osteosarcoma, and teleangiectatic osteosarcoma becomes even more complicated when the lesion arises at sites other than the long bones and presents with extensive extraosseous, soft-tissue tumor masses. The latter cases--especially when they occur as sacral or presacral tumors--present challenges with respect to successful treatment, which should combine surgical removal of the entire lesion following oncological criteria to prevent recurrences and osteosynthesis to guarantee the biomechanical stability of the spinal-pelvic junction. Here we report on the clinical case of a female patient with an aneurysmal bone cyst of the sacrum and extensive extraosseous tumor masses. The report includes the diagnostic challenges, the surgical options of sacral and/or presacral tumors, the histopathological findings, and long-term clinical and radiographic surveillance. METHODS The patient was treated by a combination of preoperative adjuvant selective arterial embolization, radical surgical excision through an anterior approach followed by subsequent osteosynthesis and stabilization through a posterior approach. RESULTS Clinical and radiographic follow-up for 2 years was uneventful, and the patient is still free of recurrence or any complaints. CONCLUSION The current report documents the diagnostic and surgical challenge of a gigantic aneurysmal bone cyst of the sacrum and its successful management.
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Affiliation(s)
- Pia Pogoda
- Department of Trauma, Hand and Reconstructive Surgery, Hamburg University School of Medicine, Martinistrasse 52, 20246 Hamburg, Germany
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38
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Dubois J, Chigot V, Grimard G, Isler M, Garel L. Sclerotherapy in aneurysmal bone cysts in children: a review of 17 cases. Pediatr Radiol 2003; 33:365-72. [PMID: 12768252 DOI: 10.1007/s00247-003-0899-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2002] [Accepted: 01/23/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the efficacy of percutaneous sclerotherapy in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS Seventeen patients (7 girls, 10 boys) with aneurysmal bone cysts were treated by the percutaneous approach with Ethibloc ( n=14) and histoacryl glue ( n=3) in our institution between January 1994 and June 2000. The cysts were located in the extremities ( n=6), pelvis ( n=2), spine ( n=2), mandible ( n=5), rib ( n=1) and sphenoid bone ( n=1). Percutaneous sclerotherapy was performed with fluoroscopic and/or computed tomographic guidance under general anesthesia. Clinical and imaging follow-up lasted from 24 months to 9 years and 6 months (mean: 57.3 months). The results were quantified as: excellent (residual cyst less than 20% of the initial involvement), satisfactory (residual cyst 30-50%), unsatisfactory (residual cyst more than 50%). RESULTS The age of the patients ranged from 4 years and 6 months to 15 years and 8 months (mean: 11 years and 2 months). In nine patients, the therapeutic procedure was repeated 2-5 times. Excellent regression was observed in 16 (94%), satisfactory results in 1 (6%). There was no failure (unsatisfactory result or no response to treatment) in this reported series. The complications were minor and included: local inflammatory reaction ( n=2), small blister ( n=1), and leakage ( n=1). Relief of symptoms was achieved in all patients. No recurrence was noted during follow-up. CONCLUSION Percutaneous sclerotherapy of aneurysmal bone cysts with Ethibloc is safe and effective. It is an important alternative to surgery, especially when surgery is technically impossible or not recommended in high-risk patients.
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Affiliation(s)
- Josée Dubois
- Department of Medical Imaging, Hôpital Sainte-Justine, 3175 Cote Sainte-Catherine Road, H3T 1C5, Montreal, Quebec, Canada.
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Dekeuwer P, Odent T, Cadilhac C, Journeau P, Langlais J, Padovani JP, Glorion C, Pouliquen JC. [Aneurysmal bone cyst of the spine in children: a 9-year follow-up of 7 cases and review of the literature]. Rev Chir Orthop Reparatrice Appar Mot 2003; 89:97-106. [PMID: 12844053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF THE STUDY Aneurysmal cyst is an uncommon benign primitive bone tumor generally observed in young subjects, in a spinal localization in 10% of the cases. We report the clinical, radiological, and therapeutic aspects of seven cases of aneurysmal cyst of the spine. MATERIAL AND METHODS This series included seven children, mean age 11.7 years (range 8-14) who were followed for 9 years on the average (range 2-24 years). Findings were compared with reports in the literature. RESULTS Four cysts were located in the cervical spine (C1, C3, C4, C7), two in the thoracic spine (T4, T7) and one in the sacrum. Biopsy-resection was performed in six patients. The sacral cyst was treated by selective arterial embolization. Two complications were observed after surgical treatment. Bony filling of the lesion, evaluated by CT scan six months after surgery, was achieved in five cases, incomplete in two without recurrence of cystic cavities. DISCUSSION AND CONCLUSION Aneurysmal bone cysts account for 15% of all primitive tumors of the spine. They are more frequent in the cervical and thoracic spine than in a lumbar or sacral localization. One vertebra is involved in most cases, generally the vertebral body and the posterior arch with an asymmetrical extension to one pedicle in some cases. Neurological complications of variable severity are frequent and can be improved by surgical removal of the tumor. CT scan and MRI are the best exams to analyze the spinal cyst, to show bony walls and liquid-liquid levels suggestive of aneurysmal bone cyst, to evaluate the tumor extension and to search for cord compression. When the CT scan and MRI show characteristic signs of aneurysmal bone cyst of the spine, we do not perform a biopsy systematically if complete removal of the tumor appears possible. Surgical removal with biopsy is the treatment of choice. Reconstruction and stabilization of the spine must be complete using bone graft with or without instrumentation. In case of medullary involvement, decompression must be performed rapidly with the most complete tumor removal as possible. Selective arterial embolization can be used in some localizations or as preparation to surgery. Radiotherapy is contraindicated in children because of the risk of radio-induced tumors.
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Affiliation(s)
- P Dekeuwer
- Service de Chirurgie Orthopédique et Traumatologique, Clinique Chirurgicale Infantile, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris Cedex 15
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Meyer S, Reinhard H, Graf N, Kramann B, Schneider G. Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl. Eur J Radiol 2002; 43:79-81. [PMID: 12065126 DOI: 10.1016/s0720-048x(01)00406-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report on a 15-year-old girl with a secondary aneurysmatic bone cyst of the thoracic spine with extension into the spinal canal on the basis of an osteoblastoma. Surgical treatment was facilitated by preoperative embolization of the highly-vascular tumor. Excision of the tumor was performed without extensive intraoperative blood loss. Following excision, transpedicular-stabilization of the spinal column was achieved using a fixateur intern. We conclude that superselective embolization of benign lesions of the spinal column constitutes a feasible means of reducing intraoperative bleeding complications, thus enhancing resectability.
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Affiliation(s)
- Sascha Meyer
- Department of Pediatrics, University Hospital of the Saarland, Kirrbergerstr., 66421 Homburg, Germany.
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41
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Abstract
STUDY DESIGN Forty-one cases of aneurysmal bone cyst of the mobile spine were retrospectively reviewed. OBJECTIVES To evaluate the role of surgical and nonsurgical treatment of aneurysmal bone cyst of the spine. SUMMARY OF BACKGROUND DATA Ten to 30% of aneurysmal bone cysts arise from the mobile spine, frequently occurring in pediatric patients. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. Intralesional surgery seems to be an effective treatment, as well as radiotherapy and embolization. METHODS All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Thirty-two patients underwent curettage (14 of them followed by radiotherapy), four were submitted to selective arterial embolization, three received radiotherapy alone, and two underwent en bloc-excision. RESULTS All patients were found alive and disease free at final follow-up evaluation. Two recurrences followed one incomplete curettage and one embolization. The combination of curettage and radiotherapy, although effective, showed the greatest incidence of late axial deformity. Selective arterial embolization was curative in three of four cases and did not affect the possibility of surgery in case of local recurrence. CONCLUSIONS If confirmed on larger series, selective arterial embolization seems to be the first treatment option for spine aneurysmal bone cyst, because of the low cost-to-benefit ratio. Diagnosis must be certain, based on pathognomonic radiographic pattern or on histologic study.- In case of neurologic involvement, pathologic fracture, technical impossibility of performing embolization, or local recurrence after at least two embolization procedures, complete intralesional excision would be the therapy of choice.
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Affiliation(s)
- S Boriani
- Department of Orthopedics and Traumatology, Maggiore Hospital, Bologna, Italy.
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42
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Abstract
OBJECTIVE AND METHOD Most of the literature about cranial aneurysmal bone cyst represents case reports, the aim of this paper is to gather information in solid clear statements about this disease in the region of the skull. This is a retrospective analysis of all available case reports on aneurysmal bone cyst involving the skull between 1960 and June 1998. The jaw was excluded. RESULTS Sixty one cases of aneurysmal bone cyst involving the skull were found. 33 were males and 28 were females. The average age at presentation was 17.5 years. A painless enlarging mass was the most common mode of presentation. Features of pressure on intracranial structures with increased intracranial pressure were present in some patients. Most patients were managed by total excision of the lesion when feasible. Partial resection resulted in recurrence in some patients. Endovascular embolization has been used as a single mode of therapy or as pre-operative to decrease the intra-operative bleeding. CONCLUSION Aneurysmal bone cysts not uncommonly affect the skull. The pathological changes are similar to those affecting other parts of the body. Clinical presentation varies and depends on the part of the skull involved. Endovascular embolization plays a very important role in the management either as pre-operative or as the only method of treatment.
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Affiliation(s)
- B Y Sheikh
- Department of Neurosurgery, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
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Affiliation(s)
- D Pang
- Pediatric Neurosurgery, Kaiser Hospitals, Sacramento, CA 95825, USA
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44
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Abstract
Thirty-one cases of aneurysmal bone cyst of the spine with a minimum follow-up of 1 year as registered by the Netherlands Committee for Bone Tumors are reported. Aneurysmal bone cyst is a benign, sometimes expansive and destructive, lesion frequently occurring between the ages of 10 and 20 years. Located in the vertebral column, it undermines the structural integrity of the spine, and neurologic complications can occur. In all cases the posterior elements were involved, with extension into the vertebral body occurring in 22 cases. Extension to adjacent vertebra occurred 5 times, but the intervertebral disc appeared to be left intact. Twenty-nine of 31 cases were treated surgically. Posterior approaches provided insufficient access to lesions also located to the vertebral body and were associated with a higher recurrence rate (5 of 18 cases) than anterior approaches (1 of 11 cases). Of 10 cases in which the surgical removal was incomplete, 4 healed and 6 had a local recurrence. Selective embolization was used twice, and its application is discussed. On the basis of this material and a review of the literature, treatment by intralesional curettage combined by adjuvant therapy such as preoperative embolization is advised.
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Guibaud L, Herbreteau D, Dubois J, Stempfle N, Bérard J, Pracros JP, Merland JJ. Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein--series of 18 cases. Radiology 1998; 208:369-73. [PMID: 9680561 DOI: 10.1148/radiology.208.2.9680561] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. RESULTS Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. CONCLUSION Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.
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Affiliation(s)
- L Guibaud
- Department of Pediatric Imaging, Hôpital Debrousse, Université Lyon-Sud, France
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46
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Abstract
Bone cysts are commonly encountered clinical problems in the pediatric age group. The most common types of cysts are the unicameral and aneurysmal bone cysts. These benign lesions vary in their aggressiveness, clinical behavior and treatment. Both of these lesions are poorly understood in terms of their etiology, but effective treatment exists. These lesions represent a source of great consternation to both clinicians and families, for they weaken the bone and may be confused with malignant lesions. This review will focus on the two most commonly encountered cystic lesions in the pediatric population.
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Affiliation(s)
- A C Hecht
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston 02114, USA
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Stella G, De Sanctis N, Boero S, Rondinella F. Benign tumors of the pediatric spine: statistical notes. Chir Organi Mov 1998; 83:15-21. [PMID: 9718811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A group of 50 pediatric patients affected with tumors or pseudotumors of the spine were studied with the purpose of determining the interval between the onset of symptoms and definitive diagnosis, the incidence of various symptoms, the statistical frequency based on age, sex, histologic type, localization, site. Also studied were diagnostic procedures adopted, therapy, recurrence, complications. The child affected with benign tumor pathology of the spine is rarely submitted early to appropriate diagnostic testing. Tumors are more frequently localized in the lumbar and thoracic spine and there is predilection for the vertebral arch. The most frequent histologic types are in decreasing order: histiocytosis X, osteoid osteoma, and aneurysmal cyst. Treatment is constituted by simple curettage in histiocytosis X, complete resection of the neoplasm in osteoid osteoma and osteoblastoma, partial resection associated with radiotherapy or selective embolization in aneurysmal bone cyst.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Bone Cysts, Aneurysmal/diagnosis
- Bone Cysts, Aneurysmal/surgery
- Bone Cysts, Aneurysmal/therapy
- Bone Diseases/diagnosis
- Child
- Child, Preschool
- Diagnosis, Differential
- Embolization, Therapeutic
- Female
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/surgery
- Humans
- Male
- Osteoblastoma/diagnosis
- Osteoblastoma/surgery
- Osteoma, Osteoid/diagnosis
- Osteoma, Osteoid/surgery
- Spinal Neoplasms/diagnosis
- Spinal Neoplasms/surgery
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Affiliation(s)
- G Stella
- II Divisione Ortopedia e Traumatologia, Istituto Scientifico Giannina Gaslini, Genova
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Green JA, Bellemore MC, Marsden FW. Embolization in the treatment of aneurysmal bone cysts. J Pediatr Orthop 1997; 17:440-3. [PMID: 9364379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Eight patients with aneurysmal bone cysts (ABC) were treated with selective embolization as an adjunct to curettage and bone graft in seven cases and as the definitive procedure in the remaining case. The age range was 5-23 years. Symptoms had been present for an average duration of 6 months. The lesions were located in the femur (three), the shoulder girdle (three), the tibia (one), and the pubis (one). Two patients had recurrent lesions, and six were primary. Average follow-up was 3 years (2-4.6 years). There were no recurrences and no complications related to embolization. All lesions ossified including the pubic lesion, which was treated with embolization alone. One patient with an ABC adjacent to the distal femoral physis had growth disturbance and a second who had an extensive acromial lesion had mild degenerative changes of the acromioclavicular joint.
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Affiliation(s)
- J A Green
- Royal Alexandra Hospital for Children, Sydney, Australia
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Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar WM. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 1997; 79:20-5. [PMID: 9020439 DOI: 10.1302/0301-620x.79b1.7097] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to 154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture. We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.
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Affiliation(s)
- H W Schreuder
- University Hospital St. Radboud, Nijmegen, The Netherlands
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50
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Abstract
Treatment of 16 patients with aggressive benign bone tumours and one patient with a low grade malignancy with a combined regimen of cryosurgery, phenolization and acrylic cementation is reported. Patients were aged between 9 and 51 years and were treated by this method between the years 1986 and 1993. Minimal follow up was 13 months. The commonest histological diagnosis was giant cell tumour (7), followed by aneurysmal bone cyst (6), chondromyxoidfibroma (3) and low grade chondrosarcoma (1). Patients were assessed for functional outcome and local recurrence. On average 86 per cent of premorbid function was restored at follow up and there was one local recurrence (6.29 per cent). We conclude that this is a satisfactory method of gaining local control of these tumours.
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Affiliation(s)
- A Devitt
- Cappagh Orthopaedic Hospital, Dublin
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