Aneurysmal Bone Cysts: Treatment with Direct Percutaneous Ethibloc Injection. Long-Term Results

Abstract

All images demonstrated a remarkable shrinkage of the cystic lesion and bone cortex thickening. In all patients, circumscribed areas of lucency persisted at radiography, corresponding to residual cystic areas without fluid-fluid levels at MRI. Pain, which was present in all the patients before treatment, was relieved within a month. According to our experience, direct percutaneous Ethibloc injection is effective in the treatment of ABC and can be recommended as the first-choice treatment. Due to its higher sensitivity MRI must be included either in the pretreatment phase to study the multilocular structure or in the imaging follow-up to evaluate the efficacy of Ethibloc in persistently non-responsive areas.

Current management of aneurysmal bone cysts

“…By inducing sclerosis of the ABC's vascular network, local control of the lesion can be achieved. Ethibloc is a radiopaque alcoholic solution that causes local fibrogenic and thrombogenic effects upon contact with ABCs [49]. Ethibloc has been associated with healing rates as high as 92 %, with nearly 25 % of patients requiring a multiple treatments [50].…”

“…Ethibloc has been associated with healing rates as high as 92 %, with nearly 25 % of patients requiring a multiple treatments [50]. Unfortunately, sclerotherapy with Ethibloc has been associated with various complications such as local inflammatory reactions in up to 94 % of patients, aseptic bone necrosis, pulmonary embolism, deep venous thrombosis, and cerebellar infarct leading to death which have led some institutions to reduce its utilization of Ethibloc [49,[51][52][53].…”

Is Sclerotherapy Better than Intralesional Excision for Treating Aneurysmal Bone Cysts?

“…Sclerotherapy is based primarily on the premises that ABC is a vascular malformation predisposed on a hemodynamic disturbance and would heal if the vascular lesion is controlled. An alcoholic solution of zein (Ethibloc 1 ; Ethicon, Inc, Somerville, NJ) has been used with healing rates of as much as 92% [1,12,14,16,19,22] and no recurrences but requires a secondary procedure in 0% [14,16,19] to 25% [12] of patients. Topouchian et al [45] raised concerns regarding the higher treatment failure (27%) and unacceptable complication rates (five of 15 patients).…”

Cisto ósseo aneurismático vertebral: estudo de três casos

“…O tratamento do cisto ósseo aneurismático continua contro v e r s o 2 3 . Suas possibilidades envolvem a ressecção simples da lesão, com ou sem enxerto ósseo; a embolização da lesão, como tratamento único ou como adjuvante ao tratamento cirúrgico; o uso de radioterapia; a injeção percutânea de Ethibloc entre outros mé-todos 2,13,21,[23][24][25] .…”