Cranial aneurysmal bone cyst: a diagnostic problem

Abstract

Aneurysmal bone cysts (ABC) are benign osteolytic lesions that are more common in young people than in adults and involve the skull only exceptionally. The origin of ABC is still debated; indeed, some authors consider ABC to be an anomalous bony reaction that is secondary to traumas or tumours. Conversely, others consider ABC to be a distinct entity. A case of a healthy young female affected by a left frontal ABC is reported here. The clinical onset was characterised by the sudden appearance of a tender and mildly painful frontal mass. Neuroradiological assessment showed a well-circumscribed lytic lesion of the frontal bone with predominantly outward extension. En bloc surgical removal of the lesion was successfully achieved; a reconstructive cranioplasty was also performed to repair the cranial defect. The rarity of the condition described, together with the absence of clear guidelines, prompted us to review the more recent literature with the twin goals of identifying radiological features and becoming able to address the diagnosis and rules for treatment of such a rare entity.

Giant Aneurysmal Bone Cyst of the Anterior Cranial Fossa and Paranasal Sinuses Presenting in Pregnancy: Case Report and Literature Review

“… 2 Lesions involving the skull are rare, comprising only 3 to 6% of all ABCs. 3 ABCs have been reported to involve both the neurocranium (ethmoidal and/or sphenoidal, 10 11 12 13 14 15 16 17 18 temporal, 19 20 21 22 23 24 25 26 27 28 29 30 occipital, 21 31 32 33 34 35 parietal, 36 37 frontal, 12 38 39 40 41 ) and viscerocranium (mandible, 42 maxilla, 43 and zygoma 44 ).…”

Intradiploic frontal bone aneurysmal bone cyst in a child: a case report

“…All 15 cases of frontal bone ABC reported subsequently in the literature were treated with surgical excision, and some of the more recent case reports describe reconstructive cranioplasty. 9,10 In the present case, the reconstruction performed using the outer table of the bone flap after excising the bone tumour is a novel approach to the surgery.…”

“…4 A review of the literature shows 15 cases of ABC of the frontal bone. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Other than the frontal bone, ABCs have been reported in the temporal, 19 parietal 20 and occipital 21 bones, as well as in the facial skeleton. Among the facial bones, ABC most commonly involves the mandible.…”

Aneurysmal Bone Cyst in Sino-nasal Region

“…Between 3 and 12% of ABCs are found in the head and neck where they most commonly arise in the mandible or maxilla [3,4]. Guida et al [9] report that lesions involving the skull comprise 3-6% of all ABCs. Very few have ever been reported in the paranasal sinuses and are exceptionally rare in the pediatric population.…”

“…Radiotherapy has been reported in cranial ABCs for refractory cases in adults. Radiotherapy has a limited success with an accepted risk of sarcomatous degeneration [9]. However, as there is a paucity of information for ethmoidal lesions particularly in children, there exists no clear consensus for radiotherapy [13].…”