Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone

Cristofaro, R. De; Biagini, R.; Boriani, Stefano; Ricci, Silvia; Ruggieri, Pietro; Rossi, Giuseppe; Fabbri, Nicola; Roversi, R

doi:10.1007/bf00195235

Cited by 149 publications

(64 citation statements)

References 10 publications

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“…It facilitates resection by minimizing blood loss and enables safer resection. 17,19,22,30,43,54,63 The estimated blood loss during resection of spinal column neoplasms after embolization (1.5-2.2 L) is less than that lost when preoperative embolization is not performed (9.5-12 L). 22,63 When feasible, provocative testing before definitive occlusion is performed to reduce complications associated with the embolization procedure.…”

Section: Discussionmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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Section: Discussionmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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“…In the series of De Cristofaro et al, 11 patients had almost complete ossification at 22 months. 6 In our patient, CT scans were obtained approximately 4 months apart and demonstrated how quickly a young patient can recover. Perhaps most importantly, this case demonstrates that arterial embolization does not deter new bone growth.…”

Section: Discussionmentioning

confidence: 68%

Serial endovascular embolization as stand-alone treatment of a sacral aneurysmal bone cyst

Doss¹,

Weaver

Didier³

et al. 2014

SPI

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Aneurysmal bone cysts (ABCs) are destructive cystic lesions of the bone and are common in children. They are expansile in nature and, therefore, may become symptomatic. These have traditionally been treated surgically; but recently, endovascular embolization has shown promise as a stand-alone therapy. The authors describe a case of an ABC highlighting the effectiveness and efficiency of endovascular treatment. A 16-year-old boy was referred for a 4-month history of radiating back pain and urinary hesitancy. Findings from his neurological examination were normal, but he had problems ambulating because of pain. Magnetic resonance imaging and CT scanning showed a cystic mass in the sacrum; a biopsy was performed and diagnosis of ABC was confirmed. Treatment options were then discussed with the family. The patient underwent 2 endovascular embolizations in approximately 1 month: Onyx 18 was involved in the first session, and N-butyl cyanoacrylate glue was used in the second session. After the first treatment, the patient experienced a dramatic decrease in pain and concomitant improvement in function. The patient went from being mildly symptomatic after the first treatment to completely asymptomatic after the second treatment. Clinical and radiographic follow-up obtained at 2, 6, and 18 months after initial treatment revealed the patient to be asymptomatic with progressive ossification. Endovascular treatment can be effective in treating symptomatic cases of ABC in which surgery would carry significant risk. Selective arterial embolization can promote sclerosis and result in an immediate and significant decrease in pain.

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“…Recurrence rate is seen as 10-44 % of cases [2,3,7]. Recently, embolotherapy has been used to treat vascular bone tumors to limit blood loss at surgery or as definitive therapy to when surgery is not feasible [18].…”

Section: Discussionmentioning

confidence: 99%

Hip Salvageable Surgery for an Extensive Aneurysmal Bone Cyst Complicated with Transcervical Neck of Femur Fracture

Dhanasekaraprabu¹,

Mahajan²,

Lal³

et al. 2013

JCR

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Abstract:Aneurysmal bone cysts are enigmatic, locally destructive, blood filled lesions of bone with unknown cause and unusual presentations. We report a case of 16 year old female with aggressive aneurysmal bone cyst of proximal left femur complicated by transcervical fracture neck of femur. As the age of the patient was not suitable for replacement, a successful attempt was made to salvage the hip with intralesional curettage and fixation with 2 fibular struts and a cancellous hip screw. Femoral head is viable till date.

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Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone

Cited by 149 publications

References 10 publications

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Serial endovascular embolization as stand-alone treatment of a sacral aneurysmal bone cyst

Hip Salvageable Surgery for an Extensive Aneurysmal Bone Cyst Complicated with Transcervical Neck of Femur Fracture

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