Treatment Of Aneurysmal Bone Cysts Research Articles

Doxycycline sclerotherapy of aneurysmal and unicameral bone cysts in the appendicular skeleton and pelvis: Single center 14-year experience

To evaluate the safety, effectiveness, and patient satisfaction of doxycycline sclerotherapy for aneurysmal bone cysts (ABCs) and unicameral bone cysts (UBCs). This is an institutional review board-approved single center retrospective review of all ABCs and UBCs of the appendicular skeleton and pelvis completing doxycycline sclerotherapy and having at least 2 years of follow-up from 2007 to 2021. Radiographic outcomes in a patient cohort were assessed with a modified Neer score. Patient-reported outcome surveys (PROs) were completed by a subgroup of the cohort assessing pain after treatment (Likert scale), functional outcomes (Patient-Reported Outcomes Measurement Instrumentation System, PROMIS), and overall patient satisfaction (adapted from Musculoskeletal Tumor Society, MSTS). Seventy-seven lesions met inclusion criteria, with 55 (71%) receiving Bone Void Filler (BVF) in addition to doxycycline. Of the 77 lesions, 76 (99%) were successfully treated. Twelve lesions (16%) recurred but resolved with additional doxycycline treatment. One lesion failed sclerotherapy, requiring surgical excision. Of the 383 total treatments performed, 17 resulted in SIR classified adverse events (9 with grade 1, 7 with grade 2, and 1 with grade 3). Twenty-five of the 77 cases (32%) completed PROs with 20 (80%) having little to no pain and 15 (60%) having no functional impairment after completing treatment. The PROs documented high levels of satisfaction, with all patients agreeing that they would undergo doxycycline sclerotherapy again if given the option. Doxycycline sclerotherapy is a safe and effective stand-alone treatment for ABCs and UBCs.

Denosumab Re-Challenge and Long-Term Efficacy for Aneurysmal Bone Cyst of the Spine: Enhanced Treatment Algorithm.

Background/Objective: Surgical treatment of aneurysmal bone cysts (ABCs) can be challenging, especially in the spine. Non-surgical treatments such as with denosumab have shown promising results in different osteolytic pathologies. This retrospective observational study aimed to evaluate the long-term clinical and radiologic response of patients with ABCs of the mobile spine treated with denosumab and propose an updated treatment algorithm. Methods: Six patients with relapsed and symptomatic ABCs of the mobile spine were treated with denosumab (120 mg subcutaneously on days 1, 8, 15, 29, and every 4 weeks thereafter) between 2012 and 2023. Disease assessments were conducted using CT and MRI at 3, 6, 9, and 12 months post-treatment. Clinical data, including pain levels, symptoms, and adverse events, were documented from patients' charts. Results: Patients underwent an initial phase of treatment with denosumab, receiving a mean of 22 administrations (range 13-42) over a median follow-up period of 41 months (range 15-98 months). Clinical improvement was observed in all patients after 4 weeks of treatment, and all patients demonstrated a radiological response after 12-24 weeks on denosumab. Three patients were progression-free after discontinuing denosumab following 13, 15, and 42 administrations, respectively. At the last follow-up, after 38, 43, and 98 months, these patients remained stable without relapse of the disease. Three patients had a relapse of disease after denosumab; two of them underwent denosumab re-challenge, while one patient received one mesenchymal stem cells (MSCs) injection. All patients showed clinical and radiological improvement and were resulted to be disease-free at the last follow-up. Conclusions: This study demonstrates the long-term efficacy and safety of denosumab in treating ABCs of the mobile spine, as well as the potential of re-challenge in managing recurrence. A treatment algorithm is proposed, positioning denosumab as a viable therapeutic option after other local treatments. Careful patient selection, monitoring, and further research are necessary to optimize denosumab use for ABCs.

Diagnosis and Current Treatment of Aneurysmal Bone Cysts.

The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.

Percutaneous sclerotherapy using polidocanol in the treatment of aneurysmal bone cysts of extremities – a report of 28 consecutive cases

Introduction and aim. Aneurysmal bone cysts (ABC) are aggressive benign lesions with high rates of recurrence rendering its treatment uniquely challenging. We report the outcome in 28 consecutive patients of ABC of extremities treated with percutaneus sclerotherapy using 3% polidocanol over a period of 5 years. Material and methods. In biopsy proven 28 ABC cases, Injection polidocanol 3% was used as sclerosing agent under fluoroscopy guidance. Injections were repeated at 6-week intervals till complete healing of cysts. Radiological and functional results were assessed by Rastogi et al. criteria, VAS score and Enneking scoring method. Results. 25 out of 26 patients (89.28%) displayed good clinical response with an average 2.56 injections per patients. The mean follow-up period was 17.04±7.08 months. Reduction in cyst volume (mean 6.86±1.48 to 0.71±1.48.) and VAS score (mean 6.72±1.51 to 0.56±1.08) and improvement in Enneking score (17.35±3.14 to 28.92±1.35) at last follow up was significant. No recurrence was reported during the study period. Treatment failure, skin sclerosis and infection were reported in one case each. Conclusion. sclerotherapy with polidocanol 3% for primary ABC is safe and effective alternate method with advantage of no surgical morbidity, having better functional score with lesser recurrence and minimal complications.

Polidocanol sclerotherapy for the treatment of aneurysmal bone cyst, with or without pathological fractures: A prospective, comparative study

IntroductionPolidocanol sclerotherapy in the treatment of aneurysmal bone cysts (ABCs) with or without pathological fractures has been a topic of debate. While some studies recommend intralesional curettage as the preferred treatment, others suggest intralesional sclerosants as an effective alternative. Material and methodsThis study evaluates the use of polidocanol-based percutaneous sclerosant therapy in 28 patients with ABCs, of which 8 patients had pathological fracture. The patients received injections every four weeks based on clinical and radiological evaluation of the cyst, and the study assessed the results and complications of the treatment. ResultsIn group A (without pathological fractures), 14 out of 17 (82.4 %) lesions healed without any significant residual lesion. Three out of 17 (17.6 %) patients required further surgical intervention and were treated by curettage and bone grafting, definitively. Minor local inflammatory reaction was observed in 3 patients, which resolved without intervention within 3–4 days. In group B, all the 8 patients (100 %) with pathological fracture in their lesions healed as Grade 1 healing, without any significant residual lesion. One patient developed an episode of anesthesia related complication (delayed recovery) which resolved within an hour, without any residual effect. At final follow up, no recurrence was seen in any patient. ConclusionThe study concludes that polidocanol sclerotherapy is an effective treatment option for patients with ABCs, with or without pathological fractures, and has the potential to become the new treatment of choice for pathological fractures due to its low invasiveness, low morbidity, and affordability. However, further research is needed to confirm the efficacy of polidocanol sclerotherapy in larger patient populations and to compare its effectiveness with other treatment options.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience.

Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.

Role of Denosumab in the Management of Aneurysmal Bone Cysts

Background The management of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody that inhibits osteoclasts. It is effective in giant cell tumours of bone (GCT) and based on the immunohistochemical similarity and relationship between GCTs and ABCs, Denosumab may also be effective in the treatment of ABCs. Aim of the Work This study aims to assess the therapeutic importance, effectiveness and side effects of denosumab administration in the management of aneurysmal bone cysts. Materials and Methods Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for the articles published from Jan. 2013 to May 2021 that reported the efficacy and safety of denosumab in patients with aneurysmal bone cysts (ABCs). Results Thirteen studies were reviewed, involving a total of 40 patients who had aneurysmal bone cysts and were treated with denosumab. Of the 13 studies, 82.5% of the patients were from case series studies (33 patients) and 17.5% were from case reports (7 patients). The clinical response rate for denosumab as a treatment for aneurysmal bone cysts was 94.7%, with statistical significance (P < .0001). No treatment-related deaths occurred in the reviewed studies. Conclusion We conclude that denosumab represents an effective treatment option for patients with ABC especially when high surgical morbidity is expected. Although denosumab therapy is associated with minimal complications, however, relapse following cessation of treatment is still possible. Finally, denosumab is a potentially safe and promising modality for medically managing ABCs that requires further investigation with prospective clinical trials.

Reply to the Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Reply to the Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Management of advanced metacarpal aneurysmal cysts: Surgical technique

The hand is a rare site for aneurysmal bone cysts (ABCs). Depending on their degree of invasiveness, treatment of ABCs ranges from medical therapy to surgical curettage and bone filling. In the most advanced cases, bone resection and reconstruction, with or without adjuvant or neoadjuvant treatment, are indicated.We describe a technique involving segmental bone resection and structural iliac graft reconstruction with carpo-metacarpal plate arthrodesis, for the management of advanced ABC involving the base of the metacarpals. The radio-clinical results of two patients operated on using this technique are presented, at 18 and 36 months.At the last follow-up, the results showed a QDASH of 15 and 10, and a PRWE of 9 and 11. Satisfaction was 10/10 in both cases. Grasp strength was 25 kg and 42 kg versus 28 kg and 40 kg on the opposite side. Pinch strength was 6 kg and 11 kg versus 7 kg and 10 kg. Metacarpophalangeal flexion was 80° and 90°. Extension was complete in both cases. Radiographs showed good graft fusion, with no lysis or signs of ABC recurrence at the last follow-up.Segmental bone resection and iliac autograft reconstruction with carpo-metacarpal plate arthrodesis represents a therapeutic option in the management of advanced ABCs of the metacarpal base.

PENATALAKSANAAN FISIOTERAPI PADA GANGGUAN GERAK DAN FUNGSI EKSTREMITAS BAWAH PADA POST OP BONE GRAFT PADA DISTAL FEMUR SINISTRA E.C ANEURYSMAL BONE CYST : CASE REPORT

Introduction : Aneurysmal bone cyst (ABC) is a benign bone lesion that can cause localized pain, swelling, and pathological fractures. Treatment of aneurysmal bone cysts (ABC) can be done with traditional measures in the form of intralesional curettage with or without bone grafting. After surgery, postoperative side effects will appear such as incision pain, swelling, decreased muscle strength and limited range of motion (ROM).
 Purpose : to determine the effect of exercise on reduce pain, increase muscle strength and increase the range of motion of joints
 Methods : the research method used is a case report. The interventions provided included Isometric Exercise, Stretching, NMES on Quadset, AROM & PROM Exercise, and static loading exercises on the left leg.
 Results : evaluation of pain scale with NPRS, ROM with goniometer, muscle strength with MMT, range of motion with Goniometer.
 Conclusions : there is an effect of giving exercise on reducing pain, increasing muscle strength and increasing ROM

Aneurysmal bone cyst of dorsal spine presenting with paraparesis in a pediatric patient: a case report

Introduction: Aneurysmal bone cyst (ABC) are rare benign tumours of spine. They most commonly presents with backache. However neurological deficit in spinal ABCs are not uncommon. Magnetic resonance imaging of ABC may sometimes be confused with osteosarcoma or Giant cell tumours. Treatment options are varied but complete excision of tumour with spine stabilisation should be the goal. Clinical case: Here we presented the case of a 13 year old girl presenting with spastic paraparesis and bladder incontinence with MRI dorsal spine suggestive of an expansile lesion of D5 body. She underwent subtotal corpectomy with fixation of spine . Biopsy was suggestive of aneurysmal bone cyst. Post operative neurological outcome was excellent and followup scans over 2 year period suggest complete remission. Discussion: ABC are non neoplastic expansile bone lesion consisting of blood filled spaces separated by connective tissue septa of bony trabeculation and osteoclastic giant cells. Similar to our case it is seen more commonly in young females. Lumbar spine has higher incidence of ABC as compared to dorsal and cervical spine. Most common presentation is backache. Surgical options for ABC include intralesional curettage, en bloc resection followed by fixation. Vertebroplasty is also a treatment option to reinforce spinal stability. Post operative radiotherapy also can be considered in partially resected cases. Although ABC have high recurrence rate of 10-44% which has been reported with 2 years following surgery. However our patients continue to have no radiological evidence of recurrence on 2 year follow up. Conclusion: ABCs are benign tumour which may present with neurological deficit. Although treatment of ABC remains controversial but early surgery with complete removal of tumour in patients with neurological deficit provides excellent recovery. However due to high recurrence rate regular follow up is necessary.

Хирургическое лечение аневризмальных костных кист поясничного отдела позвоночника: описание клинического случая

Introduction Pediatric and adolescent patients with aneurysmal bone cyst of the spine are normally treated by orthopaedic, neuro surgeons and oncologists. There is no consensus on the strategy and volume of preoperative and surgical treatment of the condition. There is a higher risk of pathological fracture and secondary neurological complications, tumor recurrence if open surgery is not performed in time. A second surgical intervention can hardly be avoided in such cases. The objective was to report the result of surgical treatment of a patient with aneurysmal bone cyst of the spine. Material and methods Outcome of a patient with an aneurysmal bone cyst of the L3 vertebra is presented. The technique of using therapeutic punctures as a preoperative preparation to be followed by an open surgical treatment is described. Absence of complaints and tumor recurrence, stability of the metal construct and bone fusion were the evaluation criteria. Results The patient was followed for 17 months after open surgery and CT scans showed no recurrence and demonstrated bone fusion at a long term. Discussion Many aspects of the course of the disease are to be considered in the treatment of children and adolescents with aneurysmal bone cyst of the spine. In our opinion, the step in the treatment of aneurysmal bone cyst of the spine should be considered Puncture for therapeutic and diagnostic purposes is to be performed to reduce pathological process is reduced, and the procedure to be followed by surgical intervention to remove the tumor. The strategy of surgical treatment would rely on impaired supporting columns of the spine, the degree of neural structure compression and a secondary spinal deformity. The need and extent of metal fixation is to be evaluated, potential vertebral growth identified, expediency of bone grafting after tumor removal, radical excision of the pathological focus to be considered. Conclusion The clinical case showed an effective combination of surgical techniques in the treatment of an aneurysmal bone cyst of the spine. Preoperative therapeutic puncture of the cyst allowed for reduction of the pathological process (decreasing pressure inside the cyst, thickening the cortical layer of the cyst and delimiting the tumor from the surrounding tissues), decreased volume of surgical intervention and blood loss due to a decreased activity of the pathological process compared to cases of untimely performed open surgery. Metal fixation in combination with bone auto- and allograft was practical for bone fusion.

Aneurysmal bone cyst: a review.

Aneurysmal bone cyst (ABC) is a benign locally destructive bone neoplasm composed of multi-loculated blood-filled cystic spaces. The most common sites of involvement are the meta-diaphysis of the long bones and posterior elements of the vertebrae. Secondary, ABC-like changes can complicate a variety of other benign and malignant primary bone neoplasms, including giant cell tumor, fibrous dysplasia, and osteosarcoma. About two-third of primary ABCs have a rearrangement of the USP6 gene, which is not present in the ABC-like changes that occur secondary to other primary bone tumors (i.e., secondary ABC). Primary ABC of bone carries a variable but generally high rate of local recurrence. This paper provides an overview of the pathophysiology, clinical presentation, radiographic and pathologic findings, treatment, and prognosis of ABC.

Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Allogenic Bone Impaction Grafting: Mid-to Long-term Results.

Recurrence is the main hinderance in treatment of aneurysmal bone cysts (ABCs). Therefore, several treatment modalities and adjuvant therapies have been proposed. In this study, we aim to evaluate the long-term effectiveness of percutaneous curettage and allogenic bone grafting as a new, minimally invasive modality in treating ABCs. We performed a retrospective review of the medical records of patients diagnosed with primary ABCs at a university hospital over a 10-year period (2000-2010). We selected all patients who were diagnosed with primary ABC in the extremities and pelvis, treated with the same surgical procedure, and were followed for at least 2 years postoperatively. All patients underwent the same procedure of percutaneous curettage and impaction of allogenic pulverized fine bone fragments (harvested from locally stored femoral heads) mixed with autologous bone marrow aspirate from the iliac bone. We reported patient's characteristics (age and gender), site and size of the lesion, presenting symptoms, Capanna classification, follow-up duration, and post-operative complications. Assessment of cyst healing was based on the appearance on radiographs according to the modified Neer classification. Nineteen patients were included in this study; 10 patients were males and nine were females. The mean age was 9.6 years (range 3-15). The location of the lesions was as follows: femur (eight), tibia (four), pelvis (four), proximal humerus (one), distal radius (one), and calcaneus (one). The most common presenting symptom was pain in the involved area. Pathological fracture was the presenting feature in two patients. The mean follow-up duration was 6.4 years (range 2-18). The earliest radiological sign of incorporation of the allograft was seen at 3 months after surgery. All patients showed bone remodeling and radiographic resolution (classified as either A or B on the modified Neer classification) of their cystic lesions within 6 months. No local recurrence, infection, or pathological fractures occurred during the follow-up period. Percutaneous curettage and impaction of allogenic bone graft mixed with autogenic bone marrow aspirate is an efficient, minimally invasive, reproducible, and affordable procedure for the treatment of primary ABCs.

Incidence and major clinical approaches of aneurismatic bone cysts: a concise systematic review

Introduction: Aneurysmal bone cysts (ABC) are pseudocysts expansive lesions. The World Health Organization (WHO) categorizes primary ABCs as cystic neoplasms that contain fibrous septa separating numerous blood-filled spaces. Approximately 70% of ABC cases are primary, while 30% are secondary. Objective: The present study aimed to carry out a concise systematic review of the main clinical findings of aneurysmal bone cysts, highlighting the incidence and prevalence, as well as the main forms of treatment. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from May 2022 to July 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 143 articles were found. In total, 73 articles were evaluated and 10 were included and evaluated in the systematic review. The symmetric funnel plot does not suggest a risk of bias. After prospecting the main literary findings, it was generally evidenced that the aneurysmal bone cyst (ABC) is a rare lesion that is more frequently found in young adults and children. It may have unpredictable behavior, with a high recurrence rate after treatment. Standard treatment consists of curettage plus local adjuvants and bone grafting to fill the void. In anatomic sites with difficult surgical access, percutaneous procedures are used (injection of sclerosing agents, radiofrequency thermal ablation, or selective arterial embolization. Medical management with bisphosphonates or denosumab has also been advocated. Conclusion: Primary ABCs involving the maxillofacial region are extremely rare and even more in patients with advanced age. Next-generation sequencing confirmed the presence of a USP6-CDH11 fusion gene, consistent with classification as a primary aneurysmal bone cyst. Sclerotherapy provided an effective and minimally invasive treatment for aneurysmal bone cysts and is particularly useful for deep injuries, challenging surgical access, and potentially injurious vital structures.

Treatment of aneurysmal bone cysts using polidocanol: Is it useful?

According to recent research, percutaneous sclerotherapy for the treatment of aneurysmal bone cysts provides a secure substitute for surgery. We share our first-hand knowledge of this approach. Ten patients who received polidocanol injections repeatedly were examined. Polidocanol was injected in doses of 2 mg per kilogram of body weight. Clinical and radiological evaluations were done up to healing. After a mean of 4.7(1-11) injections, all cysts had healed. 1 individual had a small amount of local inflammation. Our findings demonstrate the high efficacy of percutaneous sclerotherapy with polidocanol in the treatment of ABCs, as well as its low frequency of adverse effects. Our results support the information provided in earlier publications. Since surgery is associated with significant morbidity in ABCs of the pelvis and sacrum, we think the approach will be especially helpful in these cases.

Percutaneous image-guided treatment of aneurysmal bone cysts: is there a superior treatment option?

Aneurysmal bone cysts (ABCs) are often treated with intralesional surgery (curettage) with or without adjuvant treatments. Side effects and conflicting results regarding recurrence rates do not suggest one clearly superior therapy. Percutaneous therapeutic options including sclerotherapy and thermal ablation have gained popularity as potential alternatives. The purpose of this retrospective review is to report this institution's experience and results of various image-guided minimally invasive treatments in a single institution series of cases referred to interventional radiology by orthopedic surgery after surgical failure or in patients with anatomically challenging ABCs. This study identified all patients ≤18years old who received percutaneous therapy for an ABC, including cryoablation, doxycycline sclerotherapy, microwave ablation or a combination of these modalities. Procedural details, complications, imaging follow-up and clinical follow-up were analyzed. A total of 21 patients received 41 procedures, with major complications seen in 7.7% (3/39) of procedures involving cryoablation or doxycycline sclerotherapy. Patients receiving cryoablation required an average of 1.7 procedures (median: 1 procedure, range: 1-4 procedures) while patients receiving doxycycline sclerotherapyrequired an average of 3 procedures (median: 2 procedures, range: 1-6 procedures). Patients were followed clinically and with computed tomography or magnetic resonance imaging (average: 23.9months, range: 3.9-68.3months). Follow-up imaging demonstrated improvement in 17 (85%) patients. Clinically, 93.8% (15/16) of patients who presented with fracture or pain had markedly reduced or absent pain as well as no fractures. Percutaneous image-guided treatment of ABCs demonstrates a favorable efficacy and safety profile. Adding cryoablation may lead to fewer total procedures than using doxycycline sclerotherapy alone.

Surgical treatment of aneurysmal bones cysts

Introduction. Bone cysts are one of the most common tumor-like bone diseases of childhood, most often occurring in the 1st and 2nd decade of life. According to the world medical literature, there is still no consensus on the best methods of treating bone cysts.Aim – to evaluate the effectiveness of surgical treatment of aneurysmal bone cysts (ABC) in children with the use of allografts of biological (animal and human) origin.Materials and methods. This study included 56 pediatric patients with ABC treated at The National Medical Research Center for Children’s Health, Russia, Moscow. 37 patients with aneurysmal bone cysts (29 active ABC, 8 inactive ABC) underwent surgical treatment. Our follow-up period ranged from 12 months to 80 months. In the postoperative period, the examination was carried out at a period of 3, 6, 12, 18, 24 months and then once a year, while assessing: the presence/absence of the recurrence (radiologically), the timing of functional recovery of the operated segment, the timing of X-ray reconstruction of the graft, the assessment of physical and emotional components of the patients’ quality of life were evaluated using the PedsQL questionnaire at admission and within 12 months from the date of surgery.Results and discussion. In 37 cases of surgical treatment of ABC with the use of allografts of biological origin, the recurrence presented in 7 patients (19%) – these patients, who had an active ABC, required repeated surgical interventions. The average time of complete bone repair in the lesion site ranged from 9 months to 22 months (14 months on average). Functional recovery of the operated segments was on average 10 months for the upper extremities and 12 months for the lower extremities.Conclusion. The use of allografts of biological origin is effective in the case of inactive aneurysmal bone cysts. In case of active ABC the effectiveness of bone grafting with allografts of biological origin is reduced.

Sclerotherapy for Aneurysmal Bone Cyst: A Single-Center Experience.

IntroductionSclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological efficacy of sclerotherapy in the healing of the cyst cavity secondary to biopsy-proven ABC on X-rays and assess clinical efficacy on pain, recurrence, and complications.Materials and methodsBetween 2016 and 2018, 26 patients (12 females, 14 males) with biopsy-proven ABC treated by sclerotherapy were included. All patients received an injection of polidocanol 3% intralesional as standard treatment under fluoroscopic guidance. Ossification was assessed on plain X-ray, and the pain was evaluated on a visual analog scale (VAS).ResultsOssification was complete in 24 (92.3%) patients and partial in two (7.7%) patients. Eighteen patients (70%) were pain-free at the end of three months. There was an improvement in the VAS score, and clinically, there was a significant reduction in pain and swelling. Two patients developed recurrence within two years of follow-up, treated successfully by the re-application of intralesional polidocanol 3% injection.DiscussionSclerotherapy provides an effective, minimally invasive treatment for ABC and is particularly useful for deep lesions, challenging access for surgery and potentially damaging vital structures. The use of percutaneous polidocanol 3% under fluoroscopic control seems to improve the risk/benefit ratio. Its clinical and radiological efficacy makes sclerotherapy an alternative treatment option in ABC. Level of evidenceIV, prospective study