Percutaneous Treatment of Aneurysmal Bone Cysts in the Pediatric and Adolescent Population
Purpose or Case Report: Aneurysmal bone cysts (ABCs) are expansile lytic lesions and can cause significant disability and pain most commonly seen in patients 10-30 years old. This study evaluates the technical feasibility, safety, and efficacy of percutaneous management of ABCs in pediatric and adolescent patients.
Methods & Materials: In this Institutional Review Board approved retrospective study, 11 consecutive ABCs treated with doxycycline sclerotherapy and/or percutaneous ablation from December 2015 to October 2018 were evaluated. Demographics, clinical presentation, procedural details, and safety/efficacy outcomes were assessed.
Results: A total of 11 ABCs in 11 patients (average age = 13.4 yrs; range: 8-17) were treated with 22 total procedures (range: 1-4 treatments/patient). 7/11 (63.6%) ABCs presented with recurrence following surgical resection. ABC location included spine 3/11 (27.3%), pelvis 4/11 (36.4%), lower extremity 2/11 (18.1%), humerus 1/11 (9.1%), and rib 1/11 (9.1%). Doxycycline sclerotherapy alone was used in 10 procedures in 4 (36.4%) patients, cryoablation alone was used in 7 procedures in 4 (36.4%) patients, and a combination of percutaneous ablation and doxycycline was used in 5 procedures in 3 patients (27.3%).
All 22 (100%) procedures were technically successful. Clinically, 10/11 (91%) showed clinical improvement including cessation of pain and improved range of motion. Mean follow-up time= 9 months (range: 1-20 months). On imaging, 9/10 (90%) ABCs decreased in size with increasing sclerosis on follow-up imaging. 1/10 (10%) ABC did not respond to percutaneous treatment and required repeat surgical resection. One patient is awaiting imaging follow-up. 1/11 (9.1%) patient experienced a major complication of left lower-extremity paralysis, bowel incontinence, and fecal incontinence following treatment of an L4 ABC that resolved. 1/11 (9.1%) patient experienced a minor complication of transient numbness of the lateral thigh.
Conclusions: Percutaneous treatment of ABCs is a safe and efficacious treatment option in the pediatric and adolescent population.