Outcome of endovascular treatment for aneurysmal bone cysts

Purpose Surgical management of aneurysmal bone cysts (ABCs) is associated with perioperative morbidity, mortality and high recurrence. In addition, some ABCs are inoperable. We evaluated the presentation, morphology, technique and outcome of percutaneous image guided sclerotherapy for ABCs. Materials and Methods We retrospectively reviewed the medical records and imaging studies of patients with ABCs who underwent percutaneous sclerotherapy at our institution. Age, location, size, symptoms, image guidance, agents used and outcomes were documented. Symptomatic and radiological changes were evaluated and compared pre and post sclerotherapy. Results 27 pts (5-18 yrs; mean age, 11.5 yrs) including 20 nonspinal ABCs (5-18 yrs; mean age, 11.5 years) and 7 spinal ABCs (8-18 yrs; mean age, 13 yrs) underwent percutaneous sclerotherapy. Most common symptoms were pain, swelling and neurological. 21 pts had biopsy proven ABCs. Sonographic, fluoroscopic or C-arm flat-detector CT (dynaCT) as well as combinations of these modalities was used for guidance. The sclerosant agents were sodium tetradecyl sulfate (n=23), ethanol (n=12) and doxycycline (n=8); either singly or in combinations. In 7 pts (4 nonspinal, 3 spinal) sclerotherapy was combined with transarterial embolization.1-9 sclerotherapy sessions were performed (mean: 5). Range of follow-up was 2-69 (mean, 35.5) months. In 17 (85%) nonspinal and 4 (71%) spinal lesions, pain resolved, completely in 16 pts (14 nonspinal and 2 spinal) and partially in 10 pts (5 non-spinal and 5-spinal). Radiological regression was noted in 14 (70%) nonspinal and 3 (43%) spinal lesions. 3 other pts with spinal ABCs showed radiological progression and spinal instability. 6 pts (5 spinal, 1 nonspinal) required further operative interventions but with significantly lesser blood loss. There were no complications related to sclerotherapy. Conclusion Endovascular treatment is a safe and effective treatment for aneurysmal bone cysts. It can be used as definitive treatment or as a bridge to elective surgical operation. This approach provides symptomatic relief and regression of the size of most ABCs, with more favorable outcome in nonspinal lesions.