Treatment of aneurysmal bone cysts using endoscopic curettage

Abstract

BackgroundAlthough aneurysmal bone cysts (ABCs) are benign tumours, they have the potential to be locally aggressive. Various treatment approaches, such as en bloc resection, open curettage, radiotherapy, sclerotherapy, and embolization have been proposed, but the most appropriate treatment should be selected after considering the risk of tumour recurrence and treatment complications. Endoscopic curettage (ESC) may be a less invasive alternative to open curettage for ABC treatment. We aimed to describe the use of ESC for the treatment of ABCs and to report our clinical outcomes, including the incidence rate of recurrence, radiological appearance at final follow-up, time to solid union, complications, and postoperative function.MethodsBetween 1998 and 2015, 30 patients (18 men and 12 women; mean age, 17.4 years) underwent ESC for the treatment of primary ABCs at our hospital (mean postoperative follow-up, 55 months). ESC was performed under arthroscopic guidance for direct visualization, and curettage extended until normal bone was observed in the medullary cavity. To investigate bone healing after ESC, we evaluated the consolidation of cysts at the final evaluation (based on the modified Neer classification) and time to solid union after surgery, which was defined as sufficient cortical bone thickness to prevent fracture and allow physical activities.ResultsRecurrence was identified in 3 cases (10%). Curative outcomes were obtained after repeated ESC or open curettage. A log-rank analysis indicated that age < 10 years (p = 0.004) and contact of the tumour with the physis (p = 0.01) increased the risk of tumour recurrence. Residual tumours were identified in 9 cases (30%); these lesions remained inactive over the extended follow-up period. The average time to solid union after endoscopic curettage was 3.2 months. Transient radial nerve palsy was identified in 1 case. Good postoperative functional recovery occurred in all cases.ConclusionsESC is a minimally invasive technique for the treatment of ABCs, and the tumour recurrence rate is comparable to that of other standard procedures. However, the application of this method should be carefully considered, especially for patients < 10 years and when the tumour comes in contact with the physis.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2176-6) contains supplementary material, which is available to authorized users.

Efficacy of treatment interventions for primary aneurysmal bone cysts: a systematic review

“… 11 , 17 , 18 , 31 , 33 , 36 , 38 , 39 Two studies of minimally invasive curettage techniques, without adjuvant therapy or grafting, reported treatment failures or recurrence in 40% (12/30) and 22% (2/9) of cases. 30 , 32 One study evaluated open biopsy with application of a paste composed of demineralized bone and bone marrow aspirate, without any formal curettage; 24% (5/21) of patients failed to heal at a mean follow-up of 53 (24 to 106) months.…”

“… 48 Since publication of the included studies, Ethibloc has been withdrawn from commercial use. Factors associated with treatment success or failure were examined in several studies, which identified younger age of presentation, 17 , 31 , 32 , 37 involvement of the physis, 32 , 37 and previous treatment (recurrent cysts) 31 to be negative prognostic indicators. Pathological fracture was not investigated as a potential prognostic indicator.…”

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

“…In addition, direct visualization avoids blind spots or excessive curettage, which may result in intraoperative fracture or cartilage damage. Recently, in a retrospective study, Aiba et al [27] reported the use of MIET to treat 30 patients with aneurysmal bone cysts (ABCs). Good postoperative functional recovery was achieved in all patients following the procedure.…”

“…Moreover, another distinct advantage of MIET is that it provides an excellent opportunity for trainees and medical students to observe every step of the operation on a video screen, which is especially beneficial for expansion of this technique into the field of orthopedic oncology. Although limited evidence is available, some studies have shown that the MIET produces an excellent profile of efficacy for the treatment of benign bone tumors, such as giant cell tumors of the tendon sheath, simple bone cysts, aneurysmal bone cysts and chondroblastomas [24] , [25] , [26] , [27] , [28] , [29] , [30] . In China, however, few studies have evaluated this therapeutic modality, with most studies published to date comprising case reports that do not report comprehensive outcome measures (including VAS, MSTS and SF-36 scores) [31] .…”

Traumatic bone cyst of mandible: a case series

“…In another study, Aiba et al . [53] suggested endoscopic curettage as a minimally invasive method for treating aneurysmal bone cysts with a recurrence rate of 10%, which is comparable to that of other procedures. Other treatment approaches, such as application of methylprednisolone acetate, bone allografts, and insertion of gelfoam saturated with penicillin and thrombin are also tried [54].…”