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How Is an Aneurysmal Bone Cyst Treated?

Reviewed on 3/23/2021

An aneurysmal bone cyst (ABC) is a non-cancerous bone tumor (abnormal growth) found in less than 1 in 100,000 children and adolescents per year. The majority of ABCs are liquid-filled cysts, or blood-filled sacs, making them fragile and at risk of fracturing. How to treat an aneurysmal bone cyst depends on the symptoms and circumstances of each unique case.

What is an aneurysmal bone cyst?

An aneurysmal bone cyst is a destructive bone tumor, or a liquid or blood-filled sac. 70% of aneurysmal bone cysts occur in people who have no other diseases. The other 30% occur in people who already have other bone lesions (organ or tissue damage) or tumors.  

Children or adolescents are most likely to develop aneurysmal bone cysts, and they are slightly more likely in girls than boys. The symptoms of aneurysmal bone cysts may include:

  • Pain in the affected bone
  • Stiffness around the bone
  • Deformity around the bone cyst
  • Decreased range of motion
  • Swelling of the area around the bone

Diagnosis for an aneurysmal bone cyst

Only a licensed healthcare professional can diagnose an aneurysmal bone cyst. To get a diagnosis, you will need to schedule a physical examination for your child. They will undergo several different tests, including:

  • X-ray, which creates images of the bone 
  • Magnetic resonance imaging (MRI), which uses a computer, large magnets, and radio frequencies to generate images of muscles, organs, and soft tissues inside the body 
  • Computed tomography (CT) scan, which uses a computer and x-rays to look at bones 
  • EOS technology, creating 3D images taken while the child is upright or standing
  • Angiography, or an X-ray test that looks at organs and blood vessels
  • Needle biopsy, where the doctor inserts a small needle into the body to collect a piece of tissue. The tissue then goes to the lab to be analyzed for any abnormalities.

A healthcare provider will use these tests to better understand the aneurysmal bone cyst’s size and location. They will also be able to determine the best treatment options for your child.

Treatments for an aneurysmal bone cyst

There are a variety of treatments available for aneurysmal bone cysts. Some children may need one treatment, and other children may need a combination of treatments. Your doctor can help determine the best course of action to take. 

Intralesional curettage

If your child has an aneurysmal bone cyst, the doctor may complete a procedure where they scrape out the bone to remove the tumor and cyst lining.

Intraoperative adjuvants

This involves a medical procedure where the doctor uses liquid nitrogen, chemicals, or cauterization (burning of the tumor bed) to remove microscopic tumor cells.

Bone grafting

A surgical procedure where a doctor replaces missing bone with artificial material or a cadaver bone graft from a deceased donor.

Sclerotherapy

A non-surgical option where the doctor injects chemicals into the cyst in order to create scar tissue. The scar eventually heals and hardens into bone, healing the cyst.

Cryotherapy

A medical procedure where the doctor freezes the cyst. Sometimes cryotherapy takes place in addition to curettage and bone grafting.

Depending on the location and size of the removed aneurysmal bone cyst, your child may be able to go home the same day as surgery or the day after. 

Follow-up care

Because aneurysmal bone cysts may reoccur, it's important that your child sees the doctor for follow-up visits. Appointments usually take place one to two weeks after surgery, then every three to four months for a period of two years. 

During follow-up visits, the doctor will monitor your child's health, evaluate the site of the removed aneurysmal bone cyst, and ensure that there is no recurrence. An aneurysmal bone cyst will not usually return more than two years after surgery.

Possible complications and side effects

A few possible complications and side effects related to the surgery of an aneurysmal bone cyst include:

  • Significant blood loss during surgery, due to the abnormal blood vessels potentially involved
  • Risk of injury to areas near the aneurysmal bone cyst, such as nerve injury or bone fracture
  • Risk of the aneurysmal bone cyst recurring, which may happen about 20% of the time with treatment 

Doctors do everything they can to minimize the risk or the chance of the aneurysmal bone cyst returning. They may recommend prescriptions for pain management and instructions on keeping the area around the tumor clean. Different procedures have different side effects. Consult your healthcare provider about possible complications or concerns you may have about aneurysmal bone cysts. 

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References
SOURCES:

Boston Children's Hospital: "Aneurysmal Bone Cyst | Diagnosis & Treatments."

Children's Hospital of Philadelphia: "Aneurysmal Bone Cyst."

Nationwide Children's: "Aneurysmal Bone Cyst."

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