Skip to main content
Top
Published in: Skeletal Radiology 11/2011

01-11-2011 | Technical Report

Advance in the treatment of aneurysmal bone cyst of the sacrum

Authors: Davide Donati, Tommaso Frisoni, Barbara Dozza, Henry DeGroot, Ugo Albisinni, Sandro Giannini

Published in: Skeletal Radiology | Issue 11/2011

Login to get access

Abstract

Objective

The objective of this study was the review of 11 patients with two different treatment methods used historically for aneurysmal bone cyst in the sacrum. The outcome of both procedures is reported. In addition, the treatment technique of CT-guided percutaneous injections of demineralized bone matrix mixed with bone marrow concentrate is described.

Materials and methods

From 1997 to 2008, 11 patients with sacral aneurysmal bone cyst were treated at the Rizzoli Institute, Bologna, Italy. The first seven patients had surgical curettage without bone grafting, chemical adjuvants, or arterial embolization. The last four patients had arterial embolization. The last patient did not respond to arterial embolization and was treated by CT-guided injection of demineralized bone matrix mixed with bone marrow concentrate.

Results

Curettage was successful in five out of seven patients. Two patients suffered complications, and two cases had recurrence. Arterial embolization was successful in three of four patients. The patient treated with injection had a good clinical and radiographic result.

Conclusion

Both surgical and arterial embolization are effective for aneurysmal bone cyst in the sacrum. However, these treatments may lead to complications and recurrence. The use of CT-guided injections of demineralized bone matrix mixed with bone marrow concentrate may be a safe and effective alternative for treatment of these destructive and problematic lesions.
Literature
1.
go back to reference Cottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg. 2007;127(2):105–14.CrossRef Cottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg. 2007;127(2):105–14.CrossRef
2.
go back to reference Mirra JM. Aneurysmal bone cyst. In: Mirra JM, Picci P, Gold RH, editors. Bone tumors. Clinical, radiologic, and pathologic correlations. Philadelphia: Lea & Febiger; 1989. p. 1267–311. Mirra JM. Aneurysmal bone cyst. In: Mirra JM, Picci P, Gold RH, editors. Bone tumors. Clinical, radiologic, and pathologic correlations. Philadelphia: Lea & Febiger; 1989. p. 1267–311.
3.
go back to reference Campanacci M, Bertoni F, Bacchini P. Aneurysmal bone cyst. In: Campanacci M, Bertoni F, Bacchini P, editors. Bone and soft tissue tumors. Vienna: Springer; 1990. p. 725–51.CrossRef Campanacci M, Bertoni F, Bacchini P. Aneurysmal bone cyst. In: Campanacci M, Bertoni F, Bacchini P, editors. Bone and soft tissue tumors. Vienna: Springer; 1990. p. 725–51.CrossRef
4.
go back to reference Lichtenstein L. Aneurysmal bone cyst: apathological entity commonly mistaken for giant-cell tumor and occasionally for hemangioma and osteogenic sarcoma. Cancer. 1950;3:279–89.CrossRef Lichtenstein L. Aneurysmal bone cyst: apathological entity commonly mistaken for giant-cell tumor and occasionally for hemangioma and osteogenic sarcoma. Cancer. 1950;3:279–89.CrossRef
5.
go back to reference Unni KK. Dahlin’s bone tumors: general aspects and data on 11,087 cases. Philadelphia: Lippincott-Raven; 1996. p. 382–90. Unni KK. Dahlin’s bone tumors: general aspects and data on 11,087 cases. Philadelphia: Lippincott-Raven; 1996. p. 382–90.
6.
go back to reference Honl M, Westphal F, Carrero V, et al. Pelvic girdle reconstruction based on spinal fusion and ischial screw fixation in a case of aneurysmal bone cyst. Sarcoma. 2003;7(3–4):177–82.CrossRef Honl M, Westphal F, Carrero V, et al. Pelvic girdle reconstruction based on spinal fusion and ischial screw fixation in a case of aneurysmal bone cyst. Sarcoma. 2003;7(3–4):177–82.CrossRef
7.
go back to reference Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am. 2001;83:1674–81.CrossRef Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am. 2001;83:1674–81.CrossRef
8.
go back to reference Gibbs CP, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am. 1999;81(12):1671–8.CrossRef Gibbs CP, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am. 1999;81(12):1671–8.CrossRef
9.
go back to reference Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol. 2005;23(27):6756–62.CrossRef Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol. 2005;23(27):6756–62.CrossRef
10.
go back to reference Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25–36. Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25–36.
11.
go back to reference Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69:2921–31.CrossRef Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69:2921–31.CrossRef
12.
go back to reference Peeters SP, Van der Geest IC, de Rooy JW, Veth RP, Schreuder HW. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment. J Surg Oncol. 2009;100(8):719–24.CrossRef Peeters SP, Van der Geest IC, de Rooy JW, Veth RP, Schreuder HW. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment. J Surg Oncol. 2009;100(8):719–24.CrossRef
13.
go back to reference Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW. Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res. 2008;466(3):722–8.CrossRef Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW. Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res. 2008;466(3):722–8.CrossRef
14.
go back to reference Dick HM, Bigliani LU, Michelsen WJ, Johnston AD, Stinchfield FE. Adjuvant arterial embolization in the treatment of benign primary bone tumors in children. Clin Orthop Relat Res. 1979;139:133–41. Dick HM, Bigliani LU, Michelsen WJ, Johnston AD, Stinchfield FE. Adjuvant arterial embolization in the treatment of benign primary bone tumors in children. Clin Orthop Relat Res. 1979;139:133–41.
15.
go back to reference Yildirim E, Ersözlü S, Kirbaş I, Ozgür AF, Akkaya T, Karadeli E. Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagn Interv Radiol. 2007;13(1):49–52.PubMed Yildirim E, Ersözlü S, Kirbaş I, Ozgür AF, Akkaya T, Karadeli E. Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagn Interv Radiol. 2007;13(1):49–52.PubMed
16.
go back to reference Meyer S, Reinhard H, Graf N, Kramann B, Schneider G. Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl. Eur J Radiol. 2002;43(1):79–81.CrossRef Meyer S, Reinhard H, Graf N, Kramann B, Schneider G. Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl. Eur J Radiol. 2002;43(1):79–81.CrossRef
17.
go back to reference De Cristofaro R, Biagini R, Boriani S, et al. Selective arterial embolization in the treatment of aneurysmal bone cysts and angioma. Skeletal Radiol. 1992;21(8):523–7.CrossRef De Cristofaro R, Biagini R, Boriani S, et al. Selective arterial embolization in the treatment of aneurysmal bone cysts and angioma. Skeletal Radiol. 1992;21(8):523–7.CrossRef
18.
go back to reference Topouchian V, Mazda K, Hamze B, Laredo JD, Penneçot GF. Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology. 2004;232(2):522–6.CrossRef Topouchian V, Mazda K, Hamze B, Laredo JD, Penneçot GF. Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology. 2004;232(2):522–6.CrossRef
19.
go back to reference Adamsbaum C, Mascard E, Guinebretière JM, Kalifa G, Dubousset J. Intralesional Ethibloc injections in primary aneurysmal bone cysts: an efficient and safe treatment. Skeletal Radiol. 2003;32(10):559–66.CrossRef Adamsbaum C, Mascard E, Guinebretière JM, Kalifa G, Dubousset J. Intralesional Ethibloc injections in primary aneurysmal bone cysts: an efficient and safe treatment. Skeletal Radiol. 2003;32(10):559–66.CrossRef
20.
go back to reference de Gauzy JS, Abid A, Accadbled F, Knorr G, Darodes P, Cahuzac JP. Percutaneous Ethibloc injection in aneurysmal bone cysts. Skeletal Radiol. 2000;29:211–6.CrossRef de Gauzy JS, Abid A, Accadbled F, Knorr G, Darodes P, Cahuzac JP. Percutaneous Ethibloc injection in aneurysmal bone cysts. Skeletal Radiol. 2000;29:211–6.CrossRef
21.
go back to reference Falappa P, Fassari FM, Fanelli A, et al. Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection—long-term results. Cardiovasc Interv Radiol. 2002;25:282–90.CrossRef Falappa P, Fassari FM, Fanelli A, et al. Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection—long-term results. Cardiovasc Interv Radiol. 2002;25:282–90.CrossRef
22.
go back to reference Varshney MK, Rastogi S, Khan SA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468:1649–59.CrossRef Varshney MK, Rastogi S, Khan SA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468:1649–59.CrossRef
23.
go back to reference Hemmadi SS, Cole WG. Treatment of aneurysmal bone cysts with saucerization and bone marrow injection in children. J Pediatr Orthop. 1999;19(4):540–2.CrossRef Hemmadi SS, Cole WG. Treatment of aneurysmal bone cysts with saucerization and bone marrow injection in children. J Pediatr Orthop. 1999;19(4):540–2.CrossRef
24.
go back to reference Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg Am. 2005;87:2253–8.PubMed Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg Am. 2005;87:2253–8.PubMed
25.
go back to reference Rosenthal RK, Folkman J, Glowacki J. Demineralized bone implants for nonunion fractures, bone cysts, and fibrous lesions. Clin Orthop Relat Res. 1999;364:61–9.CrossRef Rosenthal RK, Folkman J, Glowacki J. Demineralized bone implants for nonunion fractures, bone cysts, and fibrous lesions. Clin Orthop Relat Res. 1999;364:61–9.CrossRef
26.
go back to reference Carpenter B, Motley T. Bone matrix therapy for aneurysmal bone cysts. J Am Podiatr Med Assoc. 2005;95(4):394–7.CrossRef Carpenter B, Motley T. Bone matrix therapy for aneurysmal bone cysts. J Am Podiatr Med Assoc. 2005;95(4):394–7.CrossRef
27.
go back to reference Bush CH, Adler Z, Drane WE, Tamurian R, Scarborough MT, Gibbs CP. Percutaneous radionuclide ablation of axial aneurysmal bone cysts. AJR Am J Roentgenol. 2010;194(1):W84–90.CrossRef Bush CH, Adler Z, Drane WE, Tamurian R, Scarborough MT, Gibbs CP. Percutaneous radionuclide ablation of axial aneurysmal bone cysts. AJR Am J Roentgenol. 2010;194(1):W84–90.CrossRef
28.
go back to reference Clayer M. Injectable form of calcium sulphate as treatment of aneurysmal bone cysts. ANZ J Surg. 2008;78:366–70.CrossRef Clayer M. Injectable form of calcium sulphate as treatment of aneurysmal bone cysts. ANZ J Surg. 2008;78:366–70.CrossRef
29.
go back to reference Di Bella C, Dozza B, Frisoni T, Cevolani L, Donati D. Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst. Clin Orthop Relat Res. 2010;22:1430–5. Di Bella C, Dozza B, Frisoni T, Cevolani L, Donati D. Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst. Clin Orthop Relat Res. 2010;22:1430–5.
30.
go back to reference Ozaki T, Hillmann A, Lindner N, Winkelmann W. Cementation of primary aneurysmal bone cyst. Clin Orthop Relat Res. 1997;337:240–8.CrossRef Ozaki T, Hillmann A, Lindner N, Winkelmann W. Cementation of primary aneurysmal bone cyst. Clin Orthop Relat Res. 1997;337:240–8.CrossRef
31.
go back to reference Vester H, Wegener B, Weiler C, Baur-Melnyk A, Jansson V, Dürr HR. First report of a solid variant of aneurysmal bone cyst in the os sacrum. Skeletal Radiol. 2010;39(1):73–7.CrossRef Vester H, Wegener B, Weiler C, Baur-Melnyk A, Jansson V, Dürr HR. First report of a solid variant of aneurysmal bone cyst in the os sacrum. Skeletal Radiol. 2010;39(1):73–7.CrossRef
32.
go back to reference Capanna R, Van Horn JR, Biagini R, Ruggieri P. Aneurysmal bone cyst of the sacrum. Skeletal Radiol. 1989;18(2):109–13.CrossRef Capanna R, Van Horn JR, Biagini R, Ruggieri P. Aneurysmal bone cyst of the sacrum. Skeletal Radiol. 1989;18(2):109–13.CrossRef
33.
go back to reference Capanna R, Sudanese A, Baldini N, Campanacci M. Phenol as an adjuvant in the control of local recurrence of benign neoplasms of bone treated by curettage. Ital J Orthop Traumatol. 1985;11(3):381–8.PubMed Capanna R, Sudanese A, Baldini N, Campanacci M. Phenol as an adjuvant in the control of local recurrence of benign neoplasms of bone treated by curettage. Ital J Orthop Traumatol. 1985;11(3):381–8.PubMed
34.
go back to reference Brastianos P, Gokaslan Z, McCarthy EF. Aneurysmal bone cysts of the sacrum: a report of ten cases and review of the literature. Iowa Orthop J. 2009;29:74–8.PubMedPubMedCentral Brastianos P, Gokaslan Z, McCarthy EF. Aneurysmal bone cysts of the sacrum: a report of ten cases and review of the literature. Iowa Orthop J. 2009;29:74–8.PubMedPubMedCentral
35.
go back to reference Pogoda P, Linhart W, Priemel M, Rueger JM, Amling M. Aneurysmal bone cysts of the sacrum clinical report and review of the literature. Arch Orthop Trauma Surg. 2003;123(5):247–51.CrossRef Pogoda P, Linhart W, Priemel M, Rueger JM, Amling M. Aneurysmal bone cysts of the sacrum clinical report and review of the literature. Arch Orthop Trauma Surg. 2003;123(5):247–51.CrossRef
36.
go back to reference Dormans JP, Hanna BG, Johnston DR, Khurana JS. Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop. 2004;421:205–11.CrossRef Dormans JP, Hanna BG, Johnston DR, Khurana JS. Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop. 2004;421:205–11.CrossRef
37.
go back to reference Cummings JE, Smith RA, Heck Jr RK. Argon beam coagulation as adjuvant treatment after curettage of aneurysmal bone cysts: a preliminary study. Clin Orthop Relat Res. 2010;468(1):231–7.CrossRef Cummings JE, Smith RA, Heck Jr RK. Argon beam coagulation as adjuvant treatment after curettage of aneurysmal bone cysts: a preliminary study. Clin Orthop Relat Res. 2010;468(1):231–7.CrossRef
38.
go back to reference Green JA, Bellemore MC, Marsden FW. Embolization in the treatment of aneurysmal bone cysts. J Pediatr Orthop. 1997;17(4):440–3.PubMed Green JA, Bellemore MC, Marsden FW. Embolization in the treatment of aneurysmal bone cysts. J Pediatr Orthop. 1997;17(4):440–3.PubMed
Metadata
Title
Advance in the treatment of aneurysmal bone cyst of the sacrum
Authors
Davide Donati
Tommaso Frisoni
Barbara Dozza
Henry DeGroot
Ugo Albisinni
Sandro Giannini
Publication date
01-11-2011
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 11/2011
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-011-1202-7

Other articles of this Issue 11/2011

Skeletal Radiology 11/2011 Go to the issue