Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol

Abstract

Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.

Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report

“…The 5% recurrence rate demonstrated in this series, particularly with juxtaphyseal lesions, provides an acceptable comparative recurrence rate [1,11,16,17,25,28,33,35,36,42,44] with which to pursue further study of this percutaneous treatment option. Furthermore, when recurrence (evidence of residual foci of tumor cells) occurs, patients are able to pursue a minimally invasive option of percutaneous treatment of small recurrent foci.…”

“…In addition, evidence of new bone healing provides key information for the physicians involved that treatment was progressing in the proper direction. Evidence of healing in 100% of patients compares favorably with surgical and nonsurgical care series [1,11,16,17,25,28,33,35,36,42,44].…”

“…In a large series, treatment with curettage and cryotherapy has a recurrence rate of 5% [33]. As an alternative to surgical treatment, percutaneous treatment of ABCs has been attempted with ethibloc and polidocanol with healing response rates ranging from 58% to 94%; the complications have included pulmonary embolism, skin necrosis, pain, swelling, and fever [1,36]. Polidocanol is not approved for use in the United States and ethibloc use has been abandoned for ABC because of major complications [41].…”

Current management of aneurysmal bone cysts

“…In a review of 72 patients with a mean follow-up of 34 months, Rastogi et al found a clinical response of 84.5 % with an average of three injections per patient [54]. In a randomized trial, Varshney et al compared polidocanol sclerotherapy with curettage, high-speed burr, and bone graft: polidocanol had a healing rate of 93.3 % compared with 84.8 % for curettage, although this difference did not reach statistical significance [50].…”

Tumour like lesions and their management: a retrospective study

“…Sclerosants, in general, act by direct damage to the endothelial lining, triggering a coagulation cascade and thrombotic occlusion of blood vessels. 11 There are earlier reports of spontaneous remission of ABC in the literature. 20 Response to autogenous bone marrow injection is also reported.…”