Percutaneous Ethibloc injection in the treatment of primary aneurysmal bone cysts

Abstract

The effects of percutaneous Ethibloc (Ethicon/Johnson & Johnson, St-Stevens-Woluwe, Belgium) injection into primary aneurysmal bone cysts were analysed. Two patients with a venous drainage after injection of a medium contrast were excluded. Twelve patients underwent at least one percutaneous injection of Ethibloc. The average follow-up period was 5.1 years. At final follow-up, six patients had complete healing of the cyst, three had partial healing and three, who had no response, were treated by curettage and bone grafting. Complete healing was observed for all the aggressive lesions. No major complications were noted. Ethibloc injection may be performed as a primary treatment of aneurysmal bone cysts if the technique is followed with precision.

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

“…In a previously published series [38], there was a recurrence rate of 2.8% using polidocanol in 72 cases. All the cases that respond to sclerotherapy continue to do so whether there is partial response (reflected by improved healing with repeat procedure) and no recurrences [1,9,10,12,14,16,19,22,45], or as in our previous [38] and current study, by complete healing even in recurrences with repeat sclerotherapy. Fourteen of 45 patients (31.1%) in our repetitive sclerotherapy group achieved complete healing with one injection.…”

“…Histopathologic evaluation of these columns revealed living bone. Nonresponsiveness to sclerotherapy has been identified in approximately 12% of patients (Table 4), requires a different procedure [1,9,10,12,14,16,19,22,45] from that used in the current study, and is commonly evident after the first injection.…”

“…Sclerotherapy [1,6,9,10,12,14,19,22,45] is a newer treatment modality [1] introduced in the 1990s, although the comparative safety (complications) and efficacy (recurrences) have not been as clearly established as for surgical methods. 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.…”

“…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).…”

Primary aneurysmal bone cysts in children: percutaneous sclerotherapy with absolute alcohol and proposal of a vascular classification

“…For Guibaud et al [7], most ABCs are similar to lowflow venous malformations, because they, like Sales de Gauzy [35], avoided sclerotherapy in some ABCs because of significant venous drainage. During sclerotherapy, we found similarities between ABCs and soft-tissue low-flow vascular malformations based on the macroscopic aspect of cyst fluid and its vascular drainage.…”