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Pathological fracture through a C-6 aneurysmal bone cyst. Case report.

The authors describe the case of an 18-year-old man who presented with complaints of weakness and paresis in his arms following an injury. Radiological examination demonstrated an aneurysmal bone cyst of C-6. The patient underwent a two-stage operation. Satisfactory results were obtained after complete resection of the lesion, laminoplasty, and anterior fusion without placement of instrumentation. The authors consider a two-stage operation supplemented by fusion without instrumentation to be the best treatment for young patients with aneurysmal bone cysts occurring at C-6.

Adolescent↗

Arterial embolization of aneurysmal bone cysts in children.

The long-term results of six aneurysmal bone cysts in children treated by selective arterial embolization are reported. All the cysts were large and difficult to treat by surgery. To date, no surgical treatment has been required in these children and an almost complete restoration of the original shape of the affected bones has been achieved.

Angiography↗

Aneurysmal bone cyst of the second cervical vertebrae causing multilevel upper cervical instability.

OBJECTIVE: Aneurysmal bone cyst (ABC) is a rare expansile osteolytic lesion of bone comprising proliferating vascular tissue lining blood-filled cystic cavities. ABCs occur most frequently in patients under age 20 and are uncommon after 30 years of age. Three to 20% of cases occur in the spine, and upper cervical involvement is rare. Lesions may grow rapidly and attain considerable size. When involving the spine, ABCs may result in instability and neurologic compromise, making prompt diagnosis and treatment imperative. We present a report of a 6-year-old child with an ABC of the second cervical vertebrae causing atlantoaxial and C2-C3 instability, treated successfully with curettage, decompression, and anterior and posterior arthrodesis with posterior instrumentation. METHODS: The patient underwent a staged procedure consisting of posterior instrumentation from occiput to C4 and curettage of the lesion followed by anterior cervical discectomy and fusion of C2-C4. The diagnosis, surgical treatment, and outcome of the case are described and relevant literature reviewed. RESULTS: The patient sustained no lasting neurologic deficits and was disease-free at 3 years of follow-up. CONCLUSIONS: ABC is a rare but potentially devastating cause of upper cervical spine instability. Prompt detection and treatment with curettage, decompression, and fusion can produce a satisfactory result and prevent spinal cord injury.

Atlanto-Axial Joint↗

[Isolated or predominant bone cysts of the femoral head].

By definition, the signs of osteoarthritis in this context are absent or minor. Isolated or predominant bone situated anywhere in the femoral head, are more or less well demarcated and occasionally multiple or multilocular. They affect men three times more frequently than women with a mean age of 34 years. Painful disability is generally moderate and intermittent for many years. Limitation of movement is minor or absent. The clinical course is very slow and rarely required surgical treatment. Aetiology: in the 23 cases observed over a period of 20 years, two thirds involved a dysmorphic femoral head: coxa plana, polyepiphyseal dysplasia, osteochondritis dissecans, occasionally associated; three cases were due to excessive pressure (dysplasia or subluxation without signs of osteoarthritis). The other possible causes were juxta-articular bone cyst, chondroblastoma, giant cell tumour and clear cell chondrosarcoma.

Adult↗

[Treatment of aneurysmal bone cyst].

The authors present the results of surgical treatment of 16 cases of aneurysmal bone cyst between 1998 and 2000. Age of patients at the onset of symptoms ranged from 5 to 15 years (average 11.3 years). In 12 cases the cysts were aggressive, and in 5 cases they were active (according to the capanne classification). In 12 cases the characteristic lining of the cyst was removed, curettage was performed and bone grafts were inserted into the bone cavity. In 3 cases autografts were used, in 2 cases both allografts and autografts were used, and in 7 cases only allografts were applied. Two cysts of the fibula were removed en-bloc, a cyst located in the scapule was treated with radiotherapy. In 15 cases the cyst was successfully managed surgically. While in 1 case a revision procedure was performed.

Adolescent↗

Removal of aneurysmal bone cyst in the area of C1, C2 and foramen magnum. Follow-up of surgical osteoplastic repair by means of 3 D CT studies 15 years later.

First, the author relates his memories of his first encounter with the new Editor-in-Chief of the Acta Neurochirurgica in 1957 and the reasons why it made such an unforgettable impression. Next, follows a discussion of the technical difficulties in the treatment of spinal aneurysmal bone cysts, which may produce extensive destruction of its bony elements. The relatively rare occurrence of these lesions and resulting limited experience provide insufficient grounds for developing rigid rules of surgical treatment. Their treatment must rather rely on experience by means of examples (paradigms). The present author's principles of surgical strategy are total removal of these cysts and repair by means of stabilizing bony autotransplants. A description is given of an unusual case of an aneurysmal bone cyst localized in the cervical-occipital transition area in which 3 D CT images give a better view on stabilization reached by osteoplastic repair of the destroyed structures than can be achieved with previous imaging methods.

Bone Cysts, Aneurysmal↗

Aspects of the pathology of stifle bone cysts in the horse.

The gross and histological appearance of subchondral bone cysts in six Thoroughbred or partbred horses is described. The lesions were all situated in the centre of the medial femoral condyle and were not associated with any other damage to the articular surface of the femorotibial or femoropatellar joints. In three cases the cysts were unilateral but had an early non-cystic lesion present in the opposite stifle. All the cysts had a narrow channel at their distal extremity which communicated with the femorotibial joint. The more recently developed ones were fluid filled and contained fibrous strands, while those in the older horses contained dense fibrotic detritus. No signs of significant ossification of the cysts were detected. The likely pathogenesis of these lesions is discussed in the light of the pathological findings.

Animals↗

Aneurysmal bone cyst of the cervical spine: report of a case investigated by computed tomographic scanning and treated by a two-stage surgical procedure.

The authors report the case of a 62-year-old woman with an aneurysmal bone cyst of the cervical spine. The patient presented with a progressive tetraparesis. Cervical computed tomographic scanning revealed a mass involving three contiguous vertebral bodies. The patient underwent two consecutive surgical procedures: (a) laminectomy and metallic plate osteosynthesis and (b) an anterior approach for curettage of the cyst and autologous grafting. Twelve months after operation, the patient was given a course of radiation therapy in the cervical area. She was found to be asymptomatic at the 20-month follow-up examination. The authors discuss the etiological, anatomical, and radiological features of vertebral aneurysmal bone cysts and evaluate treatment methods.

Bone Cysts↗

Aneurysmal bone cyst of the mandible.

The case of a 48-year-old male patient with a slowly growing mass in the right molar region of the mandible is presented. The biopsy specimen showed an aneurysmal bone cyst. After radiation therapy failed to arrest the process, the patient was treated surgically via an external approach. Between the time of the initial presentation and the date of definitive surgery 9 months later, a dramatic change was noted in the roentgenographic pattern of the lesion, demonstrating early and late stages in the development of an aneurysmal bone cyst. There has been no recurrence in a 17-year follow-up period.

Bone Cysts↗

Aneurysmal bone cyst of the orbit.

A 16-year-old girl presented with progressive, painless proptosis of the left eye. X-ray studies revealed an extensive lesion involving the left orbit, antrum, and middle cranial fossa. A biopsy confirmed the diagnosis of aneurysmal bone cyst, and the lesion was surgically excised. There has been no evidence of recurrence after three years. In a review of the literature, we were able to find only seven other cases of aneurysmal bone cyst involving the orbit.

Adolescent↗

Aneurysmal bone cyst of the orbit.

We report the case of an aneurysmal bone cyst of the left orbital roof in a 12-year-old boy who presented proptosis of the left eye and painless swelling of the left orbital rim. A 3-cm-large tumor developed in less than 3 months, with first visible signs about 2 months after a minor head injury. Radiologically, the lesion was osteolytic and multicystic. The cyst, filled with hematic fluid, was surgically removed via left frontal craniotomy and a simple curettage with high-speed bur. The patient recovered well and has been in good health throughout 14 months of follow-up.

Bone Cysts, Aneurysmal↗

Aneurysmal bone cyst: a report of three cases.

Three children presenting with aneurysmal bone cysts are described. The first patient was 10 months old with a cyst of the scapula. The second was more typical but his cyst was treated initially as a malignant tumour. In the third child the second cervical vertebra was affected which posed considerable problems of management; it was treated by radiotherapy. Despite the problems all 3 children have made a good recovery.

Adolescent↗

[Aneurysmal bone cyst of the ethmoid. Apropos of a case].

Repeated epistaxis in a 12 year old child revealed an aneurysmal bone cyst of ethmoid, an exceptional localization for this lesion. Modern imaging techniques (CT scan, NMR) provided precise data on its extent, primordial for decision as to surgical approach. NMR imaging was more effective than the CT scan for diagnosis, since blood lakes were identified, and for determination of extent, since tumoral elements were distinguished from sinusal retentions.

Bone Cysts↗

Gadolinium-DTPA enhanced magnetic resonance imaging of bone cysts in patients with rheumatoid arthritis.

OBJECTIVES: To examine the contents of intraosseous cysts in patients with rheumatoid arthritis (RA) through the signal intensity characteristics on gadolinium-DTPA (Gd-DTPA) enhanced magnetic resonance imaging. METHODS: The hand or foot joints of nine patients with the cystic form of RA (where the initial radiological abnormality consisted of intraosseous cysts without erosions) were imaged before and after intravenous administration of Gd-DTPA. A 0.6 unit, T1 weighted spin echo and T2* weighted gradient echo were used to obtain images in at least two perpendicular planes. RESULTS: Most cysts showed a low signal intensity on the non-enhanced T1 weighted (spin echo) images and a high signal intensity on the T2* weighted (gradient echo) images, consistent with a fluid content. No cyst showed an enhancement of signal intensity on the T1 weighted images after intravenous administration of Gd-DTPA, whereas synovium hyperplasia at the site of bony erosions did show an increased signal intensity after Gd-DTPA. Magnetic resonance imaging detected more cysts (as small as 2 mm) than plain films, and the cysts were located truly intraosseously. In six patients no other joint abnormalities were identified by magnetic resonance imaging; the three other patients also showed, after Gd-DTPA administration, an enhanced synovium at the site of bony erosions. CONCLUSIONS: It is suggested that intraosseous bone cysts in patients with RA do not contain hyperaemic synovial proliferation. The bone cysts in patients with the cystic form of RA may be the only joint abnormality.

Adult↗