Current strategies for the treatment of aneurysmal bone cysts

Abstract

Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.

Aneurysmal bone cyst in the cervical spine

“…Although complete surgical excision of ABCs has been associated with high rates of cure,11 12 recurrence, however, remains a concern even after complete excision 1–4 7 8 11 13. The risks of aggressive surgery include spinal instability which may necessitate spinal instrumentation and fusion 2 3.…”

“…The risks of aggressive surgery include spinal instability which may necessitate spinal instrumentation and fusion 2 3. Perioperative embolisation to aid vascular control has also been used as adjuvant therapy 1 11. Less aggressive surgical options include curettage14 while sclerotherapy is also reported to be safe and effective 11…”

Aneurysmal bone cyst inadvertently treated with chemotherapy—A series of three cases

“…Patients usually complain about pain in the affected region and sometimes pathological fractures can be observed. In plain radiograms an osteolytic lesion can be found; the magnetic resonance imaging shows cystic formations with typical fluid‐fluid levels due to blood sedimentation 2 . ABC is seen as primary neoplasm because of specific translocations of the ubiquitin‐specific protease 6 ( USP6 ) gene, which can be detected using cytogenetic studies 3 .…”

Sclerotherapy using Surgiflo and alcohol: A new alternative for the treatment of aneurysmal bone cysts

“… 8 The position of the cyst, however, limits the indications: it is not always easy in long bones, when the tumour is juxtaposed to the growth plate. 9 , 10 Surgery is also difficult in the pelvis when the lesion is not peripheral and hazardous in the spine. 6 , 11 Surgical treatment for ABCs has primarily been intra-lesional curettage that can be supplemented with various adjuvants to achieve higher healing rates and reduce recurrences.…”