Dekeuwer P, Odent T, Cadilhac C, Journeau P, Langlais J, Padovani J-P, Glorion C, Pouliquen J-C
Service de Chirurgie Orthopédique et Traumatologique, Clinique Chirurgicale Infantile, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris Cedex 15.
Rev Chir Orthop Reparatrice Appar Mot. 2003 Apr;89(2):97-106.
Aneurysmal cyst is an uncommon benign primitive bone tumor generally observed in young subjects, in a spinal localization in 10% of the cases. We report the clinical, radiological, and therapeutic aspects of seven cases of aneurysmal cyst of the spine.
This series included seven children, mean age 11.7 years (range 8-14) who were followed for 9 years on the average (range 2-24 years). Findings were compared with reports in the literature.
Four cysts were located in the cervical spine (C1, C3, C4, C7), two in the thoracic spine (T4, T7) and one in the sacrum. Biopsy-resection was performed in six patients. The sacral cyst was treated by selective arterial embolization. Two complications were observed after surgical treatment. Bony filling of the lesion, evaluated by CT scan six months after surgery, was achieved in five cases, incomplete in two without recurrence of cystic cavities.
Aneurysmal bone cysts account for 15% of all primitive tumors of the spine. They are more frequent in the cervical and thoracic spine than in a lumbar or sacral localization. One vertebra is involved in most cases, generally the vertebral body and the posterior arch with an asymmetrical extension to one pedicle in some cases. Neurological complications of variable severity are frequent and can be improved by surgical removal of the tumor. CT scan and MRI are the best exams to analyze the spinal cyst, to show bony walls and liquid-liquid levels suggestive of aneurysmal bone cyst, to evaluate the tumor extension and to search for cord compression. When the CT scan and MRI show characteristic signs of aneurysmal bone cyst of the spine, we do not perform a biopsy systematically if complete removal of the tumor appears possible. Surgical removal with biopsy is the treatment of choice. Reconstruction and stabilization of the spine must be complete using bone graft with or without instrumentation. In case of medullary involvement, decompression must be performed rapidly with the most complete tumor removal as possible. Selective arterial embolization can be used in some localizations or as preparation to surgery. Radiotherapy is contraindicated in children because of the risk of radio-induced tumors.
动脉瘤样骨囊肿是一种罕见的良性原发性骨肿瘤，多见于年轻患者，10%的病例发生于脊柱。我们报告7例脊柱动脉瘤样骨囊肿的临床、放射学及治疗方面的情况。
本系列包括7名儿童，平均年龄11.7岁（范围8 - 14岁），平均随访9年（范围2 - 24年）。将研究结果与文献报道进行比较。
4个囊肿位于颈椎（C1、C3、C4、C7），2个位于胸椎（T4、T7），1个位于骶骨。6例患者接受了活检切除。骶骨囊肿采用选择性动脉栓塞治疗。手术治疗后观察到2例并发症。术后6个月通过CT扫描评估，5例病变实现了骨填充，2例不完全填充，囊肿腔无复发。
动脉瘤样骨囊肿占脊柱所有原发性肿瘤的15%。它们在颈椎和胸椎比在腰椎或骶骨部位更常见。大多数情况下累及一个椎体，通常是椎体和后弓，有些病例不对称地延伸至一个椎弓根。不同严重程度的神经并发症很常见，手术切除肿瘤可改善症状。CT扫描和MRI是分析脊柱囊肿、显示提示动脉瘤样骨囊肿的骨壁和液 - 液平面、评估肿瘤范围以及检查脊髓受压情况的最佳检查方法。当CT扫描和MRI显示脊柱动脉瘤样骨囊肿的特征性征象，如果可能完全切除肿瘤，我们不会常规进行活检。手术切除并活检是首选治疗方法。必须使用带或不带内固定的骨移植来完成脊柱的重建和稳定。如果髓腔受累，必须尽快进行减压并尽可能完全切除肿瘤。选择性动脉栓塞可用于某些部位或作为手术准备。由于存在放射性诱导肿瘤的风险，儿童禁忌放疗。
