Primary Aneurysmal Bone Cyst and Its Recent Treatment Options: A Comparative Review of 74 Cases

Abstract

(1) Background: An aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor. Different treatment modalities are described in the literature i.e., en bloc resection, intralesional curettage and percutaneous sclerotherapy. (2) Methods: This single-center study is a review of 74 patients with primary ABCs who underwent a surgical treatment or polidocanol instillation. Cyst volume measurements using MRI and conventional radiographs are compared. (3) Results: The mean pre-interventional MRI-based cyst volume was 44.07 cm3 and the mean radiographic volume was 27.27 cm3. The recurrence rate after intralesional curettage with the need for further treatment was 38.2% (13/34). The instillation of polidocanol showed a significant reduction of the initial cyst volume (p < 0.001) but a persistent disease occurred in 29/32 cases (90.6%). In 10 of these 29 cases (34.5%) further treatment was necessary. After en bloc resection (eight cases) a local recurrence occurred in two cases (25%), in one case with the need for further treatment. (4) Conclusions: MRI scans are superior to biplanar radiographs in the examination of ABCs. Sequential percutaneous instillations of polidocanol are equally effective in the therapy of primary ABCs compared to intralesional curettage. However, several instillations have to be expected. In a considerable number of cases, a conversion to intralesional curettage or en bloc resection may be necessary.

Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment

“…This latter group also included larger lesions and lesions in more challenging locations, such as the spine, with a higher rate of complications. The results of the study [62] were similar to the study by Varshney et al [55], suggesting that percutaneous sclerotherapy and intralesional curettage were at least equally efficient in the treatment of ABC. Both Bavan et al [60] and Deventer et al [62] concluded that prospective, multicenter, randomized control studies with standardized protocols on interventions for the treatment of ABC were needed to draw a solid conclusion.…”

“…The results of the study [62] were similar to the study by Varshney et al [55], suggesting that percutaneous sclerotherapy and intralesional curettage were at least equally efficient in the treatment of ABC. Both Bavan et al [60] and Deventer et al [62] concluded that prospective, multicenter, randomized control studies with standardized protocols on interventions for the treatment of ABC were needed to draw a solid conclusion. There are multiple studies advocating for sclerotherapy of ABC in spinal locations using various sclerosing agents [63][64][65][66].…”

“…However, poorer functional outcomes and higher clinically important complications were seen with surgery [ 55 , 60 ]. In a more recent, single-center, retrospective study of 74 pediatric and adult patients, which included ABC in the axial and appendicular skeleton, Deventer et al [ 62 ] compared the most common techniques used in the treatment of ABC: intralesional curettage (34 patients), image-guided percutaneous polidocanol sclerotherapy (32 patients) and en bloc resection (8 patients). The authors found a local recurrence/persistent disease rate requiring further treatment in 44.1% of the group treated by intralesional excision.…”

“…Signs of recurrence after treatment on follow-up imaging include interval enlargement of the mass or growing focal lucent areas within the lesion on radiographs and cystic areas with fluid-fluid levels on MRI. After sclerotherapy, localized non-ossified areas can remain inside the lesion that represent fibrofatty tissue rather that residual neoplasm, but they do not grow or cause symptoms [62,71]. Several risk factors have been linked to tumor recurrence, including young age of the patient at diagnosis, particularly children younger than 5 years of age, male gender, and axial skeleton and juxtaphyseal locations of the lesion, which are technically difficult to remove due to fear of injury to the adjacent physis [71,72].…”

Sclerotherapy for Aneurysmal Bone Cyst: A Single-Center Experience

“…In a recent study, Deventer et al reported that out of 32 ABC patients treated with polidocanol sclerotherapy, 90.6% of patients had the persistent disease and 34.5% of patients further required treatment [ 30 ]. We feel the probable reason for these less satisfactory results is a radiological evaluation with an MRI scan.…”