Aneurysmal bone cyst: Is selective arterial embolization effective as curettage and bone grafting?

Abstract

IntroductionAneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. Method to treat ABC's have developed over time. The standard of care cure for ABC has been curettage with or without bone grafting of the defect but is burdened by recurrence rates of approximately 25%–31%. Based on the assumption that ABCs usually supplied by one or more pathological feeding arteries, selective arterial embolization has been described as an adjuvant preoperative procedure to reduce intra‐operative hemorrhage, and as primary treatment for lesions in difficult surgical access. In the current study, we therefore asked whether (1) a single or a repeat selective arterial embolization (SAE) for treating ABCs would produce comparable healing rates compared with curettage and bone grafting; (2) evaluated the relationship of recurrence in relation to the site of the cyst, the age, and gender of the patients; and (3) the two techniques differ in term of long‐term complication.Material and MethodsWe retrospectively reviewed 265 patients who underwent curettage and bone grafting or SAE performed at our institute from 1994 to 2018. The diagnosis of ABC was always established with percutaneous CT‐guided biopsy or open biopsy. Patients were followed clinically with plain radiographs or CT scan at 3, 6, 9, and 12 months then annually in the absence of symptoms. Treatment success was determined evaluating pre‐ and postprocedural imaging according to Chang classification.ResultsTwo hundred and nineteen were treated with curettage and bone grafting (curettage group), and 46 with SAE Group. Of the 219 patients treated with Curettage and bone grafting (curettage group), 165 out of 219 (75.3%) experienced bone healing, while local recurrence was observed in 54 cases (24.7%) after 12 months on average (range: 3–120 months) from surgery. After the first SAE, bone ossification was seen in 27 (58.7%), without needing any further treatment. Eleven recurred patients were treated with SAE (four patients need two while seven need three SAE to heal), and eight patients with curettage and bone grafting. Thirty‐eight out of 46 (82%) patients experienced bone ossification regardless the number of SAE. The overall rate of local recurrence for all patients was 26.7%. SAE group presented a lower complication rate (6%) where two patients experienced skin necrosis, and one limb‐length discrepancies (2% of all cohort).DiscussionThe use of SAE is an attractive option to treat ABC as it combines on one hand a lower complication rate than curettage and bone grafting, on the other it can be carried out in case of nonresectable ABCs, significantly reducing the size of viable ABC lesions, fostering bone remodeling and mineralization, and most importantly, significantly improving the patient's quality of life.

Cross-beam Non-vascular Fibular Graft Reconstruction in the Management of Long Bone Giant Aneurysmal Bone Cyst – A Case Series

“…To prevent the high recurrence, various adjuvants such as a high-speed burr, argon beam coagulation, phenol, liquid nitrogen, cementation, and sclerotherapy have been used to be called extended curettage [ 25 - 27 ]. Alternatively, arterial embolization and radiotherapy have also been used [ 28 ]. However, radiotherapy is associated with a risk of malignant transformation [ 14 ].…”

Modern treatment of unicameral and aneurysmatic bone cysts

“…In ABC of the pelvis and sacrum, percutaneous procedures with polidocanol, selective arterial embolization, or a combination of the two are successful treatments (21). The local recurrence rate after single or multiple selective arterial embolization was reported to be around 15%, with an incidence of complications around 3%, including skin necrosis, sciatic nerve paresthesia, and artery pseudoaneurysms (9,13,22,23).…”