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PubMed2003

[Aneurismal bone cyst in children: 17 cases].

INTRODUCTION: The aneurismal bone cyst (KOA) represents 1.5 to 4% of benign osseous tumors. It affects the young patients and its etiopathogeny is still discussed. Numerous difficulties of diagnostic, therapeutic and specially evolution, characterize this pathology. MATERIAL AND METHODS: Our study reports 17 patients who were treated between 1976 and 2000. The average age was 8 years and delay of diagnostic was 11 months. It affected the long bones in 70%, the brief bones in 25% and the flat bones in 5%. In limbs, the pathological fracture was revealing in 47%, the painful lameness in 35% and tumefaction in 18% of cases. For two vertebral locations, pain was associated with a stiff neck for the cervical spine and there was a deformation with a medullar compression for the lumbar vertebral location. The radiological aspect was typical in 82% of cases. First biopsy in 13 cases allowed to confirm the KOA in eight cases; for five cases, a second biopsy was necessary to confirm diagnosis. In four cases, diagnosis was hold on typical radiographic aspect or on the hemorrhagic nature of the cyst. The surgery was realized in 15 cases (88%), with 13 eventrations and graft (three osteosynthesis) and two complete exeresis. The radiotherapy was performed for a hemorrhagic cyst located in cervical spine. Finally, a cast immobilization alone was realized for a location of the patella. RESULTS: A good result was observed in nine cases, the recurrence in three cases, degeneracy in one case and we deplore one death following a toxic shock. Degeneracy seems to be due to an initial misunderstanding of the osteosarcoma. Three patients could not be evaluated for the study. DISCUSSION: The KOA is a solitary bone dystrophy that can be primitive, or secondary to a sometimes-sly underlying hurt. The symptomatology is varied according to the location; modern imaging allows to better defining of the KOA aspects. Biopsy is indispensable for the diagnosis, but histological confirmation is not always certain. The best treatment must permit the "carcinologic" removal of the KOA. The reconstruction will be done by graft and osteosynthesis if necessary. The injection of ethibloc and the embolisation are indicated for the voluminous and very aggressive cysts. Radiotherapy, with its important morbidity, can be used for the inoperable cases. Unpredictable evolution remains threatened by the risk of local recurrence and later, by the risk of degeneracy.

Adolescent↗
PubMed1986

Dynamic endomedullary nailing in the treatment of extensive bone cysts in young patients. A pathogenetic interpretation.

The authors discuss the treatment of 6 cases of extensive bone cysts in young patients (10-18 years of age) by elastic endomedullary nailing, all of which were successful, with complete remodelling of the bone. They advance the hypothesis that this was probably due to dispersion of the fluid by drainage along the nails, followed by natural remodelling in these young patients. The technique is illustrated. The advantages claimed are its simplicity of execution, and the reliability of the results.

Adolescent↗
PubMed1996

Simple bone cysts treated by percutaneous autologous marrow grafting. A preliminary report.

We prospectively evaluated the percutaneous injection of autogenous bone marrow for the treatment of active simple bone cysts in ten consecutive children with cysts in the proximal humerus, proximal femur or tibia. The treatment included percutaneous biopsy, aspiration of fluid and the injection of autogenous bone marrow aspirated from the iliac crest. All the patients became painfree after a mean of two weeks and resumed full activities within six weeks. All ten cysts consolidated radiologically and showed remarkable remodelling within four months. Review at 12 to 48 months showed satisfactory healing without complications. Percutaneous injection of autologous bone marrow appears to be an effective treatment for active simple bone cysts.

Adolescent↗
PubMed1991

Simple bone cysts. The effects of methylprednisolone on synovial cells in culture.

Ten years ago, a protocol using Depo-Medrol injections was developed for the treatment of unicameral bone cysts. This concept, designed by tumor surgeons and based on theory, has been cautiously approached. However, reproducible results have gradually increased clinical acceptance. Understanding the healing process has been restricted because of the lack of an experimental model. In an attempt to elucidate this mechanism of healing, a cell culture model was used to investigate the effects of methylprednisolone on synovial cells. Initially, three doses of the drug were tested and maximal changes were noted with the concentration of 40 mg/ml. Changes were then quantified by morphology, DNA assay, cell protein analysis, and electron microscopy. Results suggest that methylprednisolone may have a direct effect on the cellular component of unicameral bone cysts.

Bone Cysts↗
PubMed1992

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.

Adolescent↗
PubMed1996

Direct intraoperative sclerotherapy of an aneurysmal bone cyst of the sphenoid.

A young boy presented with a symptomatic aneurysmal bone cyst of the left great wing of the sphenoid bone. Arterial embolization had failed to produce thrombosis, and the lesion could not be resected surgically. Direct intraoperative sclerotherapy resulted in immediate thrombosis of 80% of the volume of the vascular malformation with no progression of symptoms. Two years later, the symptoms had completely resolved, and CT scans showed total ossification of the lesion.

Arteriovenous Malformations↗
PubMed2006

Aneurysmal bone cyst of the capitate: case report and a review emphasizing local recurrence.

We herein report the case of a 15-year-old boy with cystic lesion of the capitate. Magnetic resonance imaging showed that the lesion demonstrated homogenous low-intensity on T1-weighted imaging and homogenous high intensity on T2-weighted imaging. The lesion was treated by curettage and autologous bone-grafting. The histological specimen from the cystic wall showed loose fibrous tissue with capillary vessels and extravasated red blood cells. The cystic lesion was filled with blood, suggesting that the cystic lesion was actually an aneurysmal bone cyst. The present case is the second reported case of aneurysmal bone cyst of the capitate. No recurrence has been observed during the 4 years since operation. We also review the literature related to ABCs of the hand with special emphasis on local recurrence.

Adolescent↗
PubMed1976

[Data on the pathogenesis of solitary juvenile bone cysts (author's transl)].

On the basis of the histologic analysis of 45 solitary (juvenile) bone-cysts the author reveals new aspects of the pathogenesis. I. Data on sex-age-localisation are referred to. II. Due to the hemosiderosis regularly manifesting itself in the loose connective tissue layer lining the cyst and owing to the similarity to the liquified hematomas to be found elsewhere in the organism, as well as on the basis of the specific blood-supply conditions of the spongiosa of the increasing metaphysis the author presumes the intramedullary hemorrhage--possibly occurring also without fracture--to be the primary change. III. In the lining layer of the cyst, as well as in the adjacent bony tissue the author frequently observed capillary stase and to a considerable degree lymphedemas (resorption insufficiency). On the basis of these data the author presumes that the following mechanism might be hold responsible for the persisting of the cyst: The congestive (anoxic) wall of the capillary gets permeable for the proteins. Hence the fluid of high protein content, filling the cyst is constantly replaced. It is emphasized that solely the lymphatic vessels are apt to convey proteins. On the basis, however, of the histologic phenomena (lymphedema) observed, the pericystic lymphatic system is in the stage of relative insufficiency.

Adolescent↗
PubMed1979

[Essential bone cyst and its therapy].

Twenty-nine cases of unicameral bone cyst treated surgically are reported. The literature is reviewed and different methods of treatment are discussed. Important factors contributory to the risk of recurrence are identified and stressed.

Bone Cysts↗
PubMed1975

Aneurysmal bone cyst of the spine. Two cases.

Two cases of aneurysmal bone cyst of the spine are described. The age incidence and distribution of such lesions are analysed, the typical radiographic and histological appearances are described, and the difficulty in diagnosis is discussed.

Bone Cysts↗
PubMed1990

Primary bone cyst of the mandibular condyle.

Cysts of the mandibular condyle are rare and their diagnosis and treatment can be difficult. A case in a young girl is described where the histology was that of a solitary bone cyst but the presentation and behaviour more closely resembled an aneurysmal bone cyst.

Bone Cysts↗
PubMed1983

Two-stage resection and spinal stabilization for aneurysmal bone cyst. A report of two cases.

Two cases of aneurysmal bone cyst of the dorsal lumbar spine are presented with four- and seven-year follow-up periods. The lesion in each case involved the vertebral bodies and posterior elements and extended to contiguous bony structures. Both anterior and posterior staged procedures were required for maximal excision, rendering the spine extremely unstable at the involved levels. Anterior strut grafting with autogenous iliac bone was done during the first stage after the vertebral bodies had been curetted. Three weeks later the remaining dorsal elements and associated tumor were removed through a posterior approach, and the spine was stabilized with the Harrington compression-distraction system and posterior autogenous iliac crest grafts. Both patients were neurologically normal after operation, and the spines in both were stable and solidly fused. Both have remained symptom-free and have had no evidence of recurrence.

Adult↗