Surgical Management of Giant Multilevel Aneurysmal Bone Cyst of Cervical Spine in a 10-Year-Old Child: Case Report with Review of Literature (Evid Based Spine Care J 2012;3(4):55–59)

摘要

In response to the excellent case report and summary on aneurysmal bone cysts by Gurjar et al1 in the November 2012 edition of EBSJ, we felt that some additional points should be brought to the attention of the readers. In the management of these difficult but benign lesions, many good points were raised by the authors, but minimally invasive sclerotherapy was omitted. This procedure involves percutaneous puncturing, often repeated injections of a sclerosing agent, traditionally polidocanol and more recently ethanol, owing to complications reported with the former and not seen with the latter. It is a curious omission of the authors because one of the better articles considering sclerotherapy—“Is Sclerotherapy Better than Intralesional Excision for Treating Aneurysmal Bone Cysts?” by Varshney in CORR 2010—is from one of the author's institution, the All India Institute of Medical Sciences.2 In this Level II study, 94 patients were prospectively randomized into two treatment groups receiving either repetitive sclerotherapy using polidocanol or an intralesional extended curettage with autograft. With an average follow-up of more than 3 years, 93% achieved the group's criteria for healing versus 85% in the curettage control group, yet with a much more favorable complication profile. This injection-based treatment option has also been left unnoticed by other centers—as much as can be gleaned from the literature—as this form of therapy is likely not available in some institutions without more advanced interventional radiology departments.3 There is concern, however, regarding cervical aneurysmal bone cysts (ABCs) and injection of Ethibloc (polidocanol) following a case report resulting in death. This was felt to be related to tumor involvement with the vertebral artery.4 As noted by Gurjar, preoperative angiography, and if possible, embolization, are requisite studies.