Aneurysmatic bone cyst of the humerus – Introduction of a new treatment technique and presentation of a case series

Abstract text (incl. references and figure legends)

Introduction. Aneurysmatic bone cysts are described as benign but aggressively growing lesions, characterized by septate and blood-filled caverns. Especially in children and adolescents, they frequently lead to pathological fractures due to excessive destruction of the bone. Multiple therapeutic approaches e.g. curettage, radio therapy or phenol injections have been described. Literature reports local recurrence in 59%. Radical resection to prevent relapse leads to defects associated with functional impairment. Isolated or additive selective arterial embolization (SAE) of the supporting vessel is discussed as an alternative. We report a one-step treatment of aneurysmatic bone cysts of the proximal humerus providing both, a low relapse rate and good functional results.

Methods. First, interventional angiography with coil-embolization of the supplying vessels is done. Subsequently, the tumor is surgically resected and debrided with a high-frequent milling machine. Reconstruction is then performed with an allogenic fibula and cancellous bone, no further implants are required. Data collection was managed through a retrospective study including patients diagnosed with "aneurysmatic bone cyst of the proximal humerus" in the past three years and their respective therapy.

Results. In total, seven patients were treated with above described technique. Average age of all male patients was 7.6 years (range 3-10). One of them presented with a recurrence, in six patients the lesion healed with free functional outcome within the period of observation (85%). Intraoperatively, no relevant bleeding occurred.

Conclusion. In 39% of the cases of isolated SAE, further embolization is required. For conventional techniques, literature reports recurrence rates of up to 59%. Our procedure minimizes the intraoperative risk of bleeding complications and lead to a distinctively decreased risk of recurrence (15%). We therefore expect radical follow up-resections to be rarely necessary.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No