Serial endovascular embolization as stand-alone treatment of a sacral aneurysmal bone cyst

2014 ◽  
Vol 20 (2) ◽  
pp. 234-238 ◽  
Author(s):  
Vinodh T. Doss ◽  
Jason Weaver ◽  
Scott Didier ◽  
Adam S. Arthur
Keyword(s):  
Endovascular Treatment ◽  
Treatment Options ◽  
Bone Cyst ◽  
Significant Risk ◽  
Arterial Embolization ◽  
Ct Scanning ◽  
Endovascular Embolization ◽  
Cystic Mass ◽  
Cyanoacrylate Glue ◽  
Aneurysmal Bone Cysts

Aneurysmal bone cysts (ABCs) are destructive cystic lesions of the bone and are common in children. They are expansile in nature and, therefore, may become symptomatic. These have traditionally been treated surgically; but recently, endovascular embolization has shown promise as a stand-alone therapy. The authors describe a case of an ABC highlighting the effectiveness and efficiency of endovascular treatment. A 16-year-old boy was referred for a 4-month history of radiating back pain and urinary hesitancy. Findings from his neurological examination were normal, but he had problems ambulating because of pain. Magnetic resonance imaging and CT scanning showed a cystic mass in the sacrum; a biopsy was performed and diagnosis of ABC was confirmed. Treatment options were then discussed with the family. The patient underwent 2 endovascular embolizations in approximately 1 month: Onyx 18 was involved in the first session, and N-butyl cyanoacrylate glue was used in the second session. After the first treatment, the patient experienced a dramatic decrease in pain and concomitant improvement in function. The patient went from being mildly symptomatic after the first treatment to completely asymptomatic after the second treatment. Clinical and radiographic follow-up obtained at 2, 6, and 18 months after initial treatment revealed the patient to be asymptomatic with progressive ossification. Endovascular treatment can be effective in treating symptomatic cases of ABC in which surgery would carry significant risk. Selective arterial embolization can promote sclerosis and result in an immediate and significant decrease in pain.

Aneurysmal Bone Cyst of the Atlas: Successful Treatment through Selective Arterial Embolization: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. E1001-E1005 ◽  
Author(s):  
A Alex Mohit ◽  
Joseph Eskridge ◽  
Richard Ellenbogen ◽  
Christopher I. Shaffrey
Keyword(s):  
Successful Treatment ◽  
Bone Cyst ◽  
Arterial Embolization ◽  
Craniovertebral Junction ◽  
Cystic Mass ◽  
High Morbidity ◽  
Surgical Morbidity ◽  
Complete Excision ◽  
Selective Arterial Embolization ◽  
Aneurysmal Bone Cysts

Abstract OBJECTIVE AND IMPORTANCE: Aneurysmal bone cysts (ABCs) are benign and expansile osteolytic lesions that can occur in any location in the spine, including the craniovertebral junction. Aggressive resection followed by bone grafting has been the mainstay of treatment, with selective arterial embolization as a presurgical adjunct. Complete excision of these lesions at the craniovertebral junction is associated with high surgical morbidity. We report a case of successful treatment of an ABC of the atlas in a child with selective arterial embolization alone. CLINICAL PRESENTATION: A 10-year-old girl presented with persistent neck pain after a snowboarding accident. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansile cystic mass involving the right lateral mass of C1. Digital subtraction angiography revealed a tumor blush, which, along with the cystic appearance of the lesion, was consistent with an ABC. INTERVENTION: The arterial feeders to the lesion were selectively embolized with polyvinyl alcohol particles. Three sessions of embolization were required to eradicate the blood supply to the lesion completely. CONCLUSION: Complete surgical resection of ABCs at the craniovertebral junction can be associated with high morbidity secondary to the highly vascular and destructive nature of these lesions. The case discussed here demonstrates the viability of selective arterial embolization as a primary and stand-alone modality of treatment.

scholarly journals Complete resolution of a cervical spine aneurysmal bone cyst after single session of endovascular embolization: Case report

2018 ◽  
Vol 25 (3) ◽  
pp. 330-334 ◽  
Author(s):  
Runqi Wangqin ◽  
Kaya Xu ◽  
Haydy Rojas ◽  
Zeguang Ren
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Complete Resolution ◽  
Treatment Options ◽  
Bone Cyst ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Definitive Treatment ◽  
Single Session ◽  
En Bloc ◽  
Intralesional Curettage

Treatment options for aneurysmal bone cysts include intralesional curettage, segmental excision, en bloc resection and endovascular embolization. The most commonly used treatment is intralesional curettage and selective arterial embolization is normally an adjunctive therapy, not a definitive treatment. We report a case of a C1 lateral mass aneurysmal bone cyst treated with a single session of endovascular embolization. Long-term follow up demonstrated complete resolution of the cyst. A study of aneurysmal bone cyst embolization was conducted and the key points for obtaining maximal devascularization of the cyst along with embolic material and technique are discussed.

scholarly journals Aneurysmal bone cyst in thoracolumbar spine

2020 ◽  
Vol 6 (3) ◽  
pp. 20190133
Author(s):  
Alex Kiu ◽  
Tiffany Fung ◽  
Pranav Chowdhary ◽  
Sungmi Jung ◽  
Tom Powell ◽  
...  
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Thoracolumbar Spine ◽  
Cord Compression ◽  
Central Canal ◽  
Neurological Deficits ◽  
Primary Bone Tumors ◽  
Canal Stenosis ◽  
Aneurysmal Bone Cysts ◽  
Primary Bone

Aneurysmal bone cysts (ABC) are rare, benign primary bone tumors. Although benign, they can be locally aggressive resulting in erosion of bone and surrounding tissues over time. In later stages, depending on the clinical urgency, immunotherapy or surgical resection remain treatment options. This report illustrates a case of a 32-year-old female who presented with chronic worsening low back pain without neurological deficits. Radiological imaging revealed a large destructive mass arising from the thoracic spine invading into the central canal, causing critical central stenosis and cord compression. Histopathology revealed ABC. This case highlights the importance of including ABCs and other ‘benign’/locally aggressive lesions in the differential of patients with insidious musculoskeletal complaints. This case also demonstrates that one can be neurologically asymptomatic despite having critical central canal stenosis and cord compression if the causative lesion is slow growing. Understanding this allows us to arrange for most appropriate management.

scholarly journals A rare case of an expansile spinopelvic aneurysmal bone cyst managed with embolization, excision, and fusion

2021 ◽  
Vol 12 ◽  
pp. 580
Author(s):  
Rudra Mangesh Prabhu ◽  
Tushar N. Rathod ◽  
Akash Vasavda ◽  
Shivaprasad S. Kolur ◽  
Punit Tayade
Keyword(s):  
Bone Cyst ◽  
Arterial Embolization ◽  
Surgical Excision ◽  
Osteolytic Lesions ◽  
Selective Arterial Embolization ◽  
Lower Back ◽  
Spinopelvic Fixation ◽  
Aneurysmal Bone Cysts ◽  
Vertebral Bodies ◽  
Neurologically Intact

Background: Aneurysmal bone cysts (ABC) are benign osteolytic lesions of the metaphyseal regions of long bones that typically contribute to rapid bony expansion. Here, we present an ABC involving the spinopelvic region in a 15-year-old male that required embolization, surgical excision, and fusion. Case Description: A 15-year-old male, presented with gradually progressive painful lower back swelling of 4 months’ duration. Once the diagnosis of an ABC was established based on a combination of X-ray, MR, and CT studies, he underwent selective arterial embolization, extended surgical excision (i.e. curettage), with a posterior fusion. Two years postoperatively, the patient remained neurologically intact without radiographic evidence of lesion recurrence. Conclusion: Large expansile ABC involving the vertebral bodies should be managed with preoperative selective arterial embolization, surgical decompression/curettage, and spinopelvic fixation.

scholarly journals Increased blood pressure variability predicts poor outcomes from endovascular treatment for aneurysmal subarachnoid hemorrhage

2021 ◽  
Vol 79 (9) ◽  
pp. 759-765
Author(s):  
Xin-Bo Ge ◽  
Qun-Fu Yang ◽  
Zhen-Bo Liu ◽  
Tao Zhang ◽  
Chao Liang
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Blood Pressure Variability ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Endovascular Embolization ◽  
Fisher Grade ◽  
Grade 3 ◽  
Poor Outcomes

ABSTRACT Background: Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. Objective: To identify the predictive factors for poor outcomes following ET for aSAH. Methods: 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. Results: At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Conclusion: Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.

scholarly journals Embolização Arterial Seletiva no Tratamento de Volumoso Quisto Ósseo Aneurismático da Bacia

2015 ◽  
Vol 28 (6) ◽  
pp. 780 ◽  
Author(s):  
Joaquim Soares do Brito ◽  
José Portela
Keyword(s):  
Surgical Treatment ◽  
Adjuvant Treatment ◽  
Surgical Approach ◽  
Bone Cyst ◽  
Young Patients ◽  
Arterial Embolization ◽  
Bloc Resection ◽  
Bone Cysts ◽  
Selective Arterial Embolization ◽  
Aneurysmal Bone Cysts

Aneurysmal bone cysts are benign musculoskeletal tumours, which occur in young patients and, occasionally, with aggressive behaviour. Those tumours very often will need surgical treatment with curettage and bone grafting, but for aggressive lesions, in<br />bloc resection is more advisable. Aggressive tumours use to be large and sometimes with difficult surgical approach and demanding complex surgical reconstructions. In this scenario, selective arterial embolization is a possible primary or adjuvant treatment option. This paper presents a paradigmatic case, where selective arterial embolization allowed a successful treatment of a large aneurysmal bone cyst with difficult surgical resolution.

scholarly journals Aneurysmal bone cyst of thoracic spine with neurological deficit and its recurrence treated with multimodal intervention – A case report

2020 ◽  
Vol 11 ◽  
pp. 274
Author(s):  
B. Yogesh Kumar ◽  
R. Thirumal ◽  
S. G. Chander
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Arterial Embolization ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Lytic Lesion ◽  
Neurological Involvement ◽  
En Bloc ◽  
Limb Weakness ◽  
Primary Bone Tumors

Background: Aneurysmal bone cysts (ABCs) are rare, representing about 1% of primary bone tumors, and 15% of all primary spine/sacral tumors. Notably, when they are located in poorly accessible regions such as the spine and pelvis, their management may be challenging. Treatment options include selective arterial embolization (SAE), curettage, en bloc excision with reconstruction, and radiotherapy. Case Description: A 16-year-old male presented with 2 months of mid back pain, left-sided thoracic radiculopathy, and left lower limb weakness (MRC – 3/5). MR imaging revealed an expansile, lytic lesion involving the T9 vertebral body, and the left-sided posterior elements resulting in cord compression. He underwent SAE followed by intralesional excision, bone grafting, and a cage – instrumented fusion. ABC was diagnosed from the biopsy sample. Postoperatively, the pain was reduced, and he was neurologically intact. Five months later, he presented with a new lesion that was treated with repeated SAE and three doses of zoledronic acid. At the end of 2 years, the subsequent, MRI and CT studies documented new bone formation in the lytic areas, with healing of lesion; additionally, he clinically demonstrated sustained pain relief. Conclusion: Here, we emphasized the importance of surgery for patients with ABC who develop focal neurological deficits. Treatment options should include SAE with bisphosphonate therapy for lesions that recur without neurological involvement.

Skull base aneurysmal bone cyst presenting with hydrocephalus: progressive residuum obliterated by Gamma Knife stereotactic radiosurgery in a pediatric patient

2020 ◽  
Vol 26 (1) ◽  
pp. 76-81
Author(s):  
George H. Tse ◽  
Feng Y. Jiang ◽  
Matthias W. R. Radatz ◽  
Saurabh Sinha ◽  
Hesham Zaki
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Pediatric Population ◽  
Bone Cyst ◽  
Disease Free Survival ◽  
Long Term Follow Up ◽  
Aneurysmal Bone Cysts ◽  
Gamma Knife Stereotactic Radiosurgery

Aneurysmal bone cysts (ABCs) are an uncommon entity predominantly encountered in the pediatric population. The skull is rarely involved, but these cysts have been reported to arise in the skull base. Traditional treatment has been with surgery alone; however, there is a gathering body of literature that reports alternative treatments that can achieve long-term disease-free survival. However, these therapies are predominantly directed at peripheral skeletal lesions. To the authors’ knowledge, this report is the first to describe long-term follow-up of the efficacy of Gamma Knife stereotactic radiosurgery for treatment of ABC residuum in the skull base that resulted in long-term patient stability and likely ABC obliteration.

Aneurysmal Bone Cyst: A Review of 150 Patients

2005 ◽  
Vol 23 (27) ◽  
pp. 6756-6762 ◽  
Author(s):  
Henry J. Mankin ◽  
Francis J. Hornicek ◽  
Eduardo Ortiz-Cruz ◽  
Jorge Villafuerte ◽  
Mark C. Gebhardt
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Local Recurrence Rate ◽  
Bone Cyst ◽  
Secondary Development ◽  
Bone Cysts ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Treatment Protocols ◽  
Imaging Appearance ◽  
Aneurysmal Bone Cysts

PurposeWe have reviewed a series of 150 aneurysmal bone cysts treated over the last 20 years.Patients and MethodsThe lesions were principally located in the tibia, femur, pelvis, humerus, and spine and, in most cases, presented the imaging appearance originally described by Jaffe and Lichtenstein as a blowout with thin cortices.ResultsOnly one of the patients was believed to have an osteoblastoma of the spine with secondary development of an aneurysmal bone cyst, and none of the patients developed additional lesions. The patients were treated primarily with curettage and implantation of allograft chips or polymethylmethacrylate, but some patients were treated with insertion of autografts or allografts. The local recurrence rate was 20%, which is consistent with that reported by other centers.ConclusionAneurysmal bone cysts are enigmatic lesions of unknown cause and presentation and are difficult to distinguish from other lesions. Overall, the treatment is satisfactory, but it is possible that newer approaches, such as improved magnetic resonance imaging studies, may help diagnose the lesions and allow the physicians to plan for more effective treatment protocols.

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