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Modern surgical treatment of primary aneurysmal bone cyst of the spine in children and adolescents.

Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor-like condition. Treating children with spinal involvement poses special hazards due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability and balance after surgery. Twelve children with ABC treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center using modern surgical techniques and technology were retrospectively reviewed. A surgical technique using a four-step approach of intralesional curettage, high-speed bur, electrocautery, and bone grafting was found to have a significantly reduced rate of recurrence (0/8 cases) compared with traditional intralesional curettage and bone grafting (4/4 cases) (P < 0.002). Short-segment spinal fusion with instrumentation was also done in five cases immediately after excision of the ABC under the same anesthesia and was a nonsignificant marker for reduced rate of recurrence (P < 0.08), likely secondary to wide exposure. Overall, at last follow-up, all 12 patients were alive and well with no evidence of disease and no significant spinal deformity. The four-step approach to treatment of ABC of the spine with appropriate spinal instrumentation and fusion is recommended for successful treatment of this aggressive lesion.

Adolescent↗

Computed tomography in the evaluation of spinal aneurysmal bone cyst.

Computed tomographic findings in three cases of aneurysmal bone cyst (ABC) are reported. Although conventional radiography is usually adequate in the demonstration of an expansile osteolytic cavity, CT may provide additional information about tumour characteristics, localization and extent, show the lesion's relation to the spinal cord and thus be of great help in preoperative planning.

Adolescent↗

Solitary (unicameral) bone cyst. The fallen fragment sign revisited.

The fallen fragment sign is a prominent radiologic feature in a minority of cases of unicameral bone cyst (20% in this series). This sign is always associated with pathologic fracture. Intramedullary fracture fragments may be single or multiple and may or may not be entirely dislodged from overlying periosteum. The finding appears limited to unicameral bone cysts in patients with open physes. When present, the fallen fragment is a pathognomonic finding as it defines the interior of the cyst as nonsolid. This is particularly helpful in cases where absence of the cyst wall secondary to fracture can simulate an intramedullary malignancy with cortical erosion.

Adolescent↗

Aneurysmal bone cyst of the rib: report of a case.

Aneurysmal bone cysts (ABC) are rare, especially in the ribs. This lesion is considered to be a benign process, which is usually found in children and young adults. This case, however, concerns a 71-year-old patient, the oldest patient hitherto reported in Japan, and also as old as in any other published case report worldwide. Although positron emission tomography (PET) demonstrated an uptake at the lesion, two biopsies could not reveal a precise preoperative diagnosis. The clinical manifestations, etiology, pathology, and current treatment are briefly discussed. Due to difficulties in the preoperative diagnosis, and to avoid recurrence, a total excision is the recommended treatment for ABC.

Aged↗

Curettage of subchondral bone cysts in medial femoral condyles of the horse.

Fifty-one horses and unilateral or bilateral femorotibial arthrotomy with medial condyle bone cyst curettage. A total of 60 cyst were treated. Treated horses responded to the surgery three to 12 months postoperatively. In 42 horses lameness was reduced or eliminated, enabling them to return to an remain in their intended function. Of these 42 horses 35 are sound, four of which have not started training, and seven showed partial improvement, two of which had no long term follow up. Of the remaining nine horses, two showed no reduction in lameness and seven were not followed up. Arthrotomy was successful in reducing or eliminating lameness in 82 per cent of all horses and 95 per cent of those where follow-up was possible (42 of 44). Arthrotomy with subchondral bone cyst enucleation and curettage was determined to be a satisfactory treatment in anticipation of a variety of athletic activities.

Animals↗

[Bone cysts].

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Bone Cysts↗

Aneurysmal bone cyst (a study of 127 cases, 72 with longterm follow up).

127 cases of aneurysmal bone cyst are analysed, seventy two of which were followed up from one to fifteen years after treatment. Statistics on sex, age, site and localisation are reported. Symptoms, radiographic features, histological appearances and differential diagnosis are discussed. In half the cases the cyst was clearly shown to be of subperiosteal origin. The aetiology is unknown, but the pathogenesis seems to consist of a haemorrhagic and hyperplastic (not neoplastic) process which is progressive but has a tendency to become stabilised on reaching a certain point of maturation. Local excision is indicated or, in cases where this is difficult to carry out, radiotherapy. Recurrences occurred in 12 per cent of the cases, always within one year after operation. All cases were eventually cured and there was no evidence of malignant transformation.

Adolescent↗

High malignant surface osteosarcoma arising at the site of a previously treated aneurysmal bone cyst.

A patient who developed a high malignant surface osteosarcoma at the site of a previously treated aneurysmal bone cyst is reported. The patient developed the osteosarcoma 4 years after complete curettage and bone-grafting of the cyst. The clinical, radiological and light microscopic features of this case are described. A causal relationship between the preexisting aneurysmal bone cyst and osteosarcoma is discussed, but seems to be unlikely.

Adult↗

Disappearance of quadriparesis due to a huge cervicothoracic aneurysmal bone cyst.

A young man who had suffered from rheumatoid arthritis developed a huge cervicothoracic aneurysmal bone cyst and progressive quadriparesis. Complete recovery occurred after "incomplete therapy," which consisted of an open biopsy and a small dose of irradiation. This tumor was observed and characterized as a blood-filled cyst excavated from the bone. Because of the controversy in the literature over the benefit of surgery vs. irradiation, this report emphasizes the fact that even "partial" treatment may beneficially affect this tumor.

Adolescent↗

Contrast medium injected into juvenile bone cysts to analyze interior morphology and guide intracavity corticosteroid treatment.

In connection with treating juvenile bone cysts with intracavital corticosteroid injections, the interior cyst anatomy was analyzed at cystography in 13 children aged 4 to 15 years. Only 4 children had a true unicameral cyst; the others had 2 or more cysts or had compartments with free or restricted communication to the main cyst. Cysts and compartments which had not been reached by steroids may continue to grow. Optimum treatment may therefore require injections at different sites guided by cystography. Neither conventional criteria of cyst activity nor repeated bone scintigraphy 3 months after treatment could predict whether the treatment would lead to final healing.

Adolescent↗

Chest wall hamartoma. Report of two cases with secondary aneurysmal bone cysts.

Chest wall hamartoma is a rare non-neoplastic benign lesion occurring in the neonatal period with particular clinical, radiological and pathological features. Histologically, it is composed of a mixture of bone trabeculae with spindle-cell stroma, chondroblast-like cells, and mature and immature hyaline cartilage. Aneurysmal bone cyst is a benign lesion that may arise secondary to several bone processes, such as giant cell tumor, chondrosarcoma, non-ossifying fibroma or osteosarcoma. We present two new cases of chest wall hamartoma with secondary aneurysmatic bone cyst formation studied with histological and immunocytochemical methods.

Bone Cysts, Aneurysmal↗