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

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.

Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience

The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In this single-center retrospective study of 19 consecutive high-risk patients (median age, 74 years) with renal malignancies managed in 2017–2020 by SAE with NBCA followed by PCA, data about patients, tumor and procedures characteristics, complications, renal function and hemoglobin concentration before and after treatment, as well as recurrence were collected. Charlson comorbidity index was ≥4 in 89.5% of patients. Ten patients were treated by antiplatelet and/or anticoagulant therapy. Median tumor largest diameter was 3.75 cm (range, 1–6.5 cm) and R.E.N.A.L. nephrometry score was ≥7 in 80%, indicating substantial tumor complexity. No major complications were recorded and minor complications occurred in 7 patients. No residual tumor was found at 6-week imaging follow-up in 18/19 patients. Tumor recurrence was visible in 1/16 patients at 6-month imaging follow-up. No significant difference was found for renal function after treatment (p = 0.07), whereas significant decrease in hemoglobin concentration was noted (p = 0.00004), although it was relevant for only one patient who required only blood transfusion and no further intervention. SAE prior to PCA is safe and effective for managing renal malignancies in high-risk patients.

Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

Selective Arterial Embolization of Renal Angiomyolipoma: Efficacy, Tumor Volume Reduction and Complications

Objective: To evaluate the efficacy and complications of selective arterial embolization in renal angiomyolipoma and to identify predictive factors for tumor rupture.Materials and Methods: Overall, 21 patients with 25 renal angiomyolipoma (AML) underwent selective arterial embolization (SAE) between January 2008 and June 2019, comprising 15 cases involving prophylaxis embolization of a tumor >4 cm diameter and 10 involving embolization for a ruptured tumor. Multidetector computed tomography (MDCT) was performed pre- and post-SAE, using the 2D tumor diameter in the ruptured AMLs. Three-dimensional volumetry and density histogram were performed for determining the total tumor volume, fat, and angiomyogenic component reduction in the unruptured AMLs. The predictive factors for tumor rupture, the treatment outcome and complications were analyzed. Results: The clinical success rate was 84% (21/25 cases) and the technical success rate was 96% (24/25 cases). The 3D volume post-SAE within 1-3 months showed a greater decrement of the enhanced angiomyogenic component than the fat component, with median percentages of -62.2% and -18.4%, respectively (p-value = 0.333). Minor complications were post-embolization syndrome (5 case, 20%) and minimal renal infarction (4 cases, 16%). Renal abscesses were the major complications (3 cases, 12%). A factor associated with tumor rupture was the presence of an intra-tumoral aneurysm (p-value < 0.05).Conclusion: SAE is an effective treatment for renal AML with a high technical and clinical success rate and limited complications. Three-dimensional volume measurement and density histogram analysis might be better tools than two-dimensional CT to evaluate post-SAE response, which is crucial for management planning.

A Comparison of Laparoscopic Enucleation with Preoperative Selective Arterial Embolization (SAE) and Non-SAE for Renal Angiomyolipoma: A Meta-Analysis

Background: To compare the outcomes of laparoscopic enucleation with preoperative selective arterial embolization (SAE) and non-SAE for renal angiomyolipoma (RAML), we performed this systematic review and meta-analysis. Methods: We searched Web of Science, PubMed, EMBASE, the Cochrane Library, the Web of Science Core Collection, ClinicalTrials.gov, and China National Knowledge Infrastructure up to May 2019. Pooled relative ratio (RR) and standardized mean difference (SMD) with their 95% confidence intervals (CIs) were used to estimate the perioperative outcomes assessing the effectiveness and safety of laparoscopic enucleation with SAE and non-SAE.Results: A total of 4 studies were incorporated. The results showed that SAE group had a shorter operative time (SMD -2.15, 95% CI: -2.85 to -1.46, P < 0.001) , less blood loss (SMD -1.77, 95% CI: -2.06 to -1.47, P < 0.001), shorter warm ischemia time (SMD -2.57, 95% CI: -3.04 to -2.10, P < 0.001), and lower postoperative complication rate (RR 0.29, 95% CI: 0.08 to 0.98, P = 0.047), compared with the Non-SAE group. However, there was no significant difference in length of stay after operation (SMD -0.82, 95% CI: -3.26 to 1.63, P = 0.512), postoperative serum creatinine (SMD -0.59, 95% CI: -1.35 to 0.18, P =0.133), and GFR (SMD 0.59, 95% CI: -0.15 to 1.32, P =0.116) between the two groups. Sensitivity analysis showed that the results of our meta-analysis were robust, and deleting anyone study had no significant effect on the pooled results.Conclusions: Laparoscopic enucleation with preoperative SAE can shorten the operation time and warm ischemia time, decrease blood loss, preserve the renal function, and reduce the incidence of complications, which is a good option for the treatment of large RAMLs.