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

Abstract

<jats:p>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.</jats:p> <jats:p>The patient underwent 2 endovascular embolizations in approximately 1 month: Onyx 18 was involved in the first session, and <jats:italic>N</jats:italic>-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.</jats:p> <jats:p>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.</jats:p>

Painful, pediatric sacral aneurysmal bone cyst treated by curettage and fresh frozen allograft

“…After intralesional curettage, the risk of recurrence is estimated to be approximately between 10-20% but large, extensive lesions necessitate en bloc resections like hemi or total sacrectomy with sacroiliac fixation which may lead to neurologic compromises like bowel and bladder dysfunction. [3,5] In this case, intralesional curettage with bone grafting provided an excellent clinical outcome avoiding a more aggressive surgery.…”

“…Preoperative selective arterial embolization (SAE) is the current updated treatment modality prior to surgical resection in order to avoid a possible major intraoperative hemorrhage. [3] …”

“…neurological compromise. [3] A differential diagnosis between benign bone tumors should be done before performing treatment. The accepted treatment for aneurysmal bone cysts in the sacrum is aggressive curettage or en bloc resection followed by local adjuvant treatments and bone grafting.…”

Imaging features of Vertebral Aneurysmal Bone Cyst and the clinical value of interventional embolization

“…In addition, radiotherapy carries other risks such as myelopathy and radiation-induced spinal deformity. Interventional embolization can affect the lesion's hemodynamic features, thus promoting the repair process ( 21 , 22 ). Identification of the blood vessels responsible for the tumour's blood supply is critical for preoperative embolization.…”

Minimizing bleeding complications in spinal tumor surgery with preoperative Onyx embolization via dual-lumen balloon catheter

“…Mean devascularization has ranged from 80% to 100%. In one case of a sacral aneurysmal bone cyst, serial embolizations completely eliminated the lesion and obviated surgery 10. There have been no reported non-target embolizations.…”