What is the treatment for aneurysmal bone cysts?

Treatment of Aneurysmal Bone Cysts

Intralesional curettage combined with cryosurgery as local adjuvant therapy is the preferred treatment for aneurysmal bone cysts, achieving a recurrence rate of only 5% with excellent functional outcomes. 1

Primary Treatment Approach

Standard Surgical Treatment

• Perform intralesional curettage (manual plus motorized high-speed burr) with local adjuvants and bone grafting as the standard treatment approach 2
• Cryosurgery as adjuvant therapy after curettage significantly reduces local recurrence rates compared to curettage alone, with only 4 recurrences in 80 consecutive cases (5% recurrence rate) 1
• The combination achieves excellent functional outcomes with an average musculoskeletal tumor society (MSTS) score of 29.2 1

Minimally Invasive Alternative

• Percutaneous curettage with allogenic bone impaction grafting mixed with autologous bone marrow aspirate represents an effective minimally invasive option 3
• This technique achieves 100% radiographic resolution within 6 months with no local recurrences, infections, or pathological fractures during long-term follow-up (mean 6.4 years) 3
• Earliest radiological signs of allograft incorporation appear at 3 months post-surgery 3

Location-Specific Considerations

Spinal Aneurysmal Bone Cysts

• Radical surgical excision should be the primary goal to minimize recurrence risk 4
• Total excision achieves significantly lower recurrence rates (1/13 cases, 7.7%) compared to subtotal resection (4/5 cases, 80%) 4
• Surgical approaches include posterior (most common), anterolateral, or combined anterior-posterior depending on tumor location 4
• Selective arterial embolization (SAE) serves as pre-operative adjunct for large lesions to reduce intraoperative bleeding, or as primary treatment for surgically inaccessible spinal lesions 2

Anatomically Difficult Locations

• Use percutaneous procedures or selective arterial embolization when surgical access is challenging 2
• Sclerotherapy injection shows effective consolidation with functional results potentially superior to open surgery 5
• Radiofrequency thermal ablation (RFTA) represents another percutaneous option 2

Adjuvant and Alternative Therapies

Medical Management

• Denosumab or bisphosphonates can be effective for medical management in select cases 5, 2
• These pharmaceutical interventions are particularly useful when surgical options are limited or contraindicated 5

Radiotherapy

• Avoid radiotherapy except as last resort due to serious adverse effects, despite good local control rates 5
• Radiotherapy may be considered only when other treatment modalities have failed or are contraindicated 5

Management of Recurrence

• All local recurrences should be treated with repeat curettage and cryosurgery 1
• Recurrences after initial treatment with curettage and cryosurgery occurred at 7-33 months and were successfully managed with the same technique 1
• The significantly higher recurrence rate with subtotal excision (80%) versus total excision (7.7%) emphasizes the importance of complete initial resection when feasible 4

Complications and Monitoring

• Expected complications include rare fractures (1/80), wound infections (1/80), and transient nerve palsies (3/80) with curettage and cryosurgery 1
• Pathological fracture at presentation occurs in a minority of cases and does not preclude standard treatment 3
• Follow-up should include physical examination and radiographs for minimum 24 months, with radiographic assessment using modified Neer classification 1, 3