Aneurysmal bone cysts treated by superselective embolization

A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.

Nonsurgical treatment of cubital subchondral cyst-like lesions in horses: seven cases (1983-1987)

Subchondral cyst-like lesions of the cubital joint were diagnosed in 7 horses at the teaching hospital between 1983 and 1987. Diagnosis of the lesions was made by administration of intra-articular local anesthesia and/or radiographically. Initial treatment for all horses consisted of stall rest for 60 to 90 days. In addition, 2 horses were administered sodium hyaluronate intra-articularly, 1 horse was given injections of polysulfated glycosaminoglycans IM, and 1 horse was given phenylbutazone orally. Follow-up information was compiled 6 weeks to 4 years after initial examination. At the time of follow-up inquiry, 6 horses were sound for intended use and only 1 horse became lame when exercised. A logical approach to choice of surgical or nonsurgical treatment is proposed on the basis of these findings and those reported in the literature.

[Arterioembolization with shape memory angioembolus. Experimental study and clinical application]

The results of experimental study and clinical application of arterio-embolization induced by the conical spiral or rugby spiral type of shape memory angioembolus(Nitinol-Conical Rugby Embolus, NT-CRE) were reported. The NT-CRE has a spring coil as its base line and is formed like a conical spiral or rugby spiral which has a two-way memory effect. Through a period of 1-48 weeks observation on 74 angiographic and histological specimens of 39 target arteries from 20 experimental dogs showed that the NT-CRE has good histocompatibility and is effective for embolization in large-bored arteries. Clinical application on target arteries of 7 patients showed successful occlusion of blood flow in 5-18 minutes in arteries with internal diameters of 3.33-5.83 mm. The NT-CRE being of the two-way memory effect and its configuration of relatively close state render its catheterization and release into target vessel simple, save, rapid and effective. In the researches we have not found any complication of hemorrhage from ruptured blood vessels and misembolization from regurgitation.

Simple bone cysts. A review of 59 cases with special reference to their treatment

In a retrospective study, 21 simple bone cysts (SBC) treated by curettage (with or without bone grafting) are compared to 20 SBC treated by intralesional injections of methylprednisolone. Curettage led to 43% favourable results and 29% recurrences. Cortisone injections led to 90% favourable results and 5% recurrences. Combined therapy (curettage and injections) led to results comparable to injections only. In our experience, curettage and hydroxyapatite grafting led to 100% complete healing (only 2 cases). We recommend intralesional methylprednisolone injections because the method is easy, effective and safe.

Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases

Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.

Selective arterial embolization in orthopaedic pathology. Analysis of long-term results

9 patients with tumorous and tumor-like skeletal lesions are examined; the patients were treated by selective arterial embolization, therapeutic, adjuvant and palliative, with follow-up ranging from 2 to 10 years. For therapeutic purposes 12 cases were constituted by aneurysmal bone cyst of large size and which was difficult to treat surgically (pelvis: 5; spine: 3; limbs: 4). For the purposes of assisting the excision procedure, selective arterial embolization was used in 2 patients with giant cell tumor of bone, the first localized in the right iliac wing and the second in the sacrum; in one patient with retroperitoneal teratoma and in 1 with hemangiopericytoma of the soft tissues of the thigh. Furthermore, in 3 patients with inoperable multiple bone metastasis, selective arterial embolization was used in order to relieve pain as palliative SAE. The authors emphasize that complete healing of aneurysmal bone cyst is possible, with no recurrence after more than 10 years; they also stress the role played by selective arterial embolization as an adjuvant particularly in the pre-surgical treatment of large giant cell tumor of bone.

Indication and procedure of the operative treatment of benign bone cysts in children and adolescents

In 2-3 reviews 30 patients with non ossifying fibroma and 31 patients with a solitary bone cyst were examined to evaluate the prognosis of these diseases. It has been shown that the cure rate of non ossifying fibromas of 95% and solitary bone cysts of 70% is extraordinarily good and does not depend on the treatment that has been realized. For that reason, the indication for operative treatment must be differentiated: Non ossifying fibromas should be left to spontaneous healing. Solitary bone cysts in the upper limb should be treated by puncture only when they show great activity, otherwise they can be left to spontaneous healing, too. In the lower limb active cysts with or without fracture should be operated, while inactive cysts should to be cured by puncture only.

Aneurysmal bone cyst of the cuboid

Aneurysmal bone cysts are a rare entity encountered in podiatric medicine. The frequency of aneurysmal bone cysts distal to the ankle joint is low. The authors present a literature review of the etiologies and possible treatments of an aneurysmal bone cyst. An unusual case of an aneurysmal bone cyst in the cuboid is also presented. Only one other documented case of an aneurysmal bone cyst in the cuboid has been reported since 1967.

Percutaneous transcatheter arterial embolization of bone and soft tissue tumors

Arterial embolization was performed in 36 patients with tumors of bone and soft tissue. Embolization was the only treatment in seven patients with benign lesions. Fourteen patients underwent embolization before surgery to obtain hemostasis and/or reduce tumor size. Fifteen patients with inoperable primary bone tumors or skeletal metastases underwent palliative embolization. The best results were obtained in aneurysmal bone cysts.

Therapeutic embolization of aneurysmal bone cyst

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.

Interventional angiography in neuropediatrics

Since the introduction of non-invasive imaging techniques (CT, US, MRI), superselective cerebrospinal angiography has been playing a major role as a diagnostic tool as well as a therapeutic procedure prior to surgery or as an alternative. Surgical neuroangiography is now also a well-established therapeutic technique in neuropediatrics. Lesions fed by the external carotid artery and spinal cord lesions are the main indications. The first group consists of maxillofacial vascular malformations, nasopharyngeal angiofibromas, and vascularized tumors of the facioorbital area (hemangiopericytoma, angiosarcoma ...). Spinal lesions for which embolization can be considered are benign tumors of the vertebral column (vertebral hemangioma, aneurysmal bone cyst ...) and vascular malformations intrinsic to the spinal cord. Particles (Ivalon, dura) are the safest embolization materials and have a wide range of possible applications; glues such as IBC have defined but limited indications. Digital subtraction angiography is crucial during the procedure and in determining the overall doses of contrast medium to be administered. Furthermore, decisions can be made more rapidly and precisely, with a definite improvement in the therapeutic results.

[Solitary bone cyst in childhood: form of presentation and course in 13 cases]

The authors describe 13 cases of solitary bone cyst in children of both sexes, ages 4 5/12 to 12 4/12 years. Ten patients were males. In eight cases the lesions were located in the humerus, three in the femur, one in the tibia and another in the phalanx of the foot. Pathological fracture was the most frequent initial symptom. The characteristic radiological image of the cyst allows the distinction of other bone lesions and is usually enough for the diagnosis. In 8 cases treatment consisted of intracystic injections of methylprednisolone acetate. In three cases relapse was observed.

Biopsy proven eradication of an aneurysmal bone cyst treated by superselective embolization: a case report

A large aneurysmal bone cyst of the upper tibia in a 17-year-old patient was treated by superselective embolization with excellent clinical and radiological results. Extensive curettage and detailed pathologic analysis performed 2 years following embolization revealed only healing bone. The presented case and reviewed cases in the literature indicate that embolization is a promising method for definitive therapy of the aneurysmal bone cyst.

Aneurysmal bone cyst: clinicopathologic features and treatment of ten cases involving the hand

Ten cases of aneurysmal bone cyst in the hand were identified among 208 such lesions in our institutional files. The patients (six women and four men) had a mean age of 27.3 years. Two patients had open physes. Seven lesions were in the metacarpals. Radiographic examination showed that in all cases the lesion was both expansile and completely lucent. There were no recurrences in the three patients treated by complete excision and bone grafting. Curettage and bone grafting in seven cases was associated with four recurrences. Three of these four local recurrences were treated successfully with curettage procedures. Treatment of aneurysmal bone cysts of the small bones of the hand requires either thorough exteriorization, curettage, and bone grafting or excision and bone grafting.

Aneurysmal bone cysts of the jaws: a case study and review of the literature

Although first documented in 1958, the definitive explanation of the etiology and pathogenesis of the aneurysmal bone cyst has yet to be elucidated. This may be attributable to the relatively small number of cases contained within the literature. The following report and review of the pertinent literature is presented to add to the current body of knowledge on the subject.

Unicameral bone cysts--comparison between surgical and steroid injection treatment

Two series of 20 patients each with unicameral bone cysts were compared, one treated before 1975 by curettage and bone grafting and the other treated after 1975 with methylprednisolone acetate (MPA) injections. At follow-up, the majority of patients were at the end of skeletal growth. In the MPA-treated series, the average age of the patients at diagnosis was 9.1 years, whereas the average age at follow-up was 16.7 years. The average follow-up interval was 7 years. The steroid-treated series had better radiographic final results than the surgically treated series, with a lower recurrence rate. The number of MPA injections required to heal the lesion ranged from one to six, with 70% of the patients requiring a maximum of three injections. Steroid injection treatment should be preferred to surgical treatment for the better final results, for the virtual absence of complications, and for the greater simplicity of execution and postoperative care.