Current management of aneurysmal bone cysts

Abstract

Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as Bfluid-fluid levels,^although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.

Denosumab treatment in aneurysmal bone cyst: Evaluation of nine cases

“…There were five males and four females with a median age of 12.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) years at diagnosis. The median age at the beginning of denosumab treatment was 12.58 (range 5-18) years.…”

“…Complete improvement may generally not be possible with those treatments unless a wide resection has been performed, which may not be feasible in most of the cases because of potential functional and anatomical deficits. The recurrence rate in incomplete resection exceeds 20% . As a result, new and potentially less invasive treatments for ABC are being investigated.…”

“…The recurrence rate in incomplete resection exceeds 20%. 2,4 As a result, new and potentially less invasive treatments for ABC are being investigated. Lange et al 5 used denosumab in a case of ABC for the first time.…”

Massive aneurysmal bone cyst of the skull base treated with denosumab

“…However, they found BRC in only 14% of cases of aneurysmal bone cysts. 13,14 For the common scenario in which aneurysmal bone cysts is difficult to distinguish from TOS or other giant-cell containing lesions, genomic analysis is an invaluable tool. While fine-needle aspiration is less expensive, less invasive, and relatively easy to perform, Creager et al concluded that FNA does not yield findings that are specific enough to diagnose aneurysmal bone cysts.…”

“…12 Due to the lack of conclusive evidence on minimally invasive diagnostic techniques, the American Academy of Orthopedic Surgery still designates open biopsy as the standard of care. 13,14 For the common scenario in which aneurysmal bone cysts is difficult to distinguish from TOS or other giant-cell containing lesions, genomic analysis is an invaluable tool. Szuhai FIGURE 4 Metabolic response to denosumab treatment PET/CT in left column showing metabolically active aneurysmal bone cysts of the right maxillary sinus and anterior skull base prior to treatment.…”