Une nouvelle alternative pour le traitement du kyste osseux anevrysmal – résultats préliminaires du Surgiflo percutané

Abstract

Aneurysmal bone cysts (ABC) are benign bone lesions that can be locally aggressive causing bone destruction and pathological fracture. Traditional treatments consist of surgery (curettage or excision), and or intralesional sclerotherapy. Ethibloc was one of the most effective fibrosing agents but was withdrawn because of reported local and general complications. The purpose of this preliminary study was to evaluate the results of a percutaneous haemostatic agent Sugiflo (Ethicon) in the treatment of active and aggressive ABC. Thirteen consecutive patients with ABC were treated in our institution between December 2009 and June 2013, at an average age of 10.1 years (3.2–17.4) by percutaneous intracystic administration of a mixture of a haemostatic agent Surgiflo and pure alcohol. The cysts were located in the proximal humerus (5), proximal tibia (3), distal femur (2), iliac bone (1), L3 (1), and C4 (1). Six patients were previously treated with surgical curettage (3), internal fixation (2) or surgical excision (1). The mixture was administered under fluoroscopic and or computed tomographic guidance under local, regional or general anesthesia. Patients were assessed clinically and radiologically at an average follow-up of 16 months (6–42). The number of required procedures per patient, the improvement of pain, rate of pathologic fracture if any, tumor volume, distance to the physis, as well as improvement in cortical thickness were assessed. Complications and recurrences were recorded. The procedure was performed once in 12 patients, and twice in 1 patient. At last follow-up, 12 patients were pain free. One patient with a very aggressive ABC of C4 developed neurologic symptoms 2 months following the procedure due to vertebral collapse and cord compression and required surgical resection and cervical fusion. There was a decrease in mean tumor volume by 13%, an increase in mean distance between physis and tumor of 7.9 mm, and in mean cortical bone thickness of 2.5 mm. The complications were minor and included postoperative pain for 3 weeks (1 case) and slight limb shortening (3 cases). Percutaneous administration of Surgiflo for active and aggressive ABCs seems to be effective and safe and shows promising results. It is an easier alternative to surgery mainly in some specific locations for which surgery may be associated with a high morbidity.