Mohit A Alex, Eskridge Joseph, Ellenbogen Richard, Shaffrey Christopher I
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Neurosurgery. 2004 Oct;55(4):982. doi: 10.1227/01.neu.0000137279.58768.7e.
Aneurysmal bone cysts (ABCs) are benign and expansile osteolytic lesions that can occur in any location in the spine, including the craniovertebral junction. Aggressive resection followed by bone grafting has been the mainstay of treatment, with selective arterial embolization as a presurgical adjunct. Complete excision of these lesions at the craniovertebral junction is associated with high surgical morbidity. We report a case of successful treatment of an ABC of the atlas in a child with selective arterial embolization alone.
A 10-year-old girl presented with persistent neck pain after a snowboarding accident. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansile cystic mass involving the right lateral mass of C1. Digital subtraction angiography revealed a tumor blush, which, along with the cystic appearance of the lesion, was consistent with an ABC.
The arterial feeders to the lesion were selectively embolized with polyvinyl alcohol particles. Three sessions of embolization were required to eradicate the blood supply to the lesion completely.
Complete surgical resection of ABCs at the craniovertebral junction can be associated with high morbidity secondary to the highly vascular and destructive nature of these lesions. The case discussed here demonstrates the viability of selective arterial embolization as a primary and stand-alone modality of treatment.
动脉瘤样骨囊肿（ABCs）是良性、膨胀性溶骨性病变，可发生于脊柱的任何部位，包括颅颈交界区。积极切除后植骨一直是主要治疗方法，选择性动脉栓塞作为术前辅助手段。在颅颈交界区完全切除这些病变会导致较高的手术并发症发生率。我们报告一例仅通过选择性动脉栓塞成功治疗儿童寰椎ABC的病例。
一名10岁女孩在一次单板滑雪事故后出现持续性颈部疼痛。颈椎计算机断层扫描和磁共振成像显示一个膨胀性囊性肿块，累及C1右侧侧块。数字减影血管造影显示肿瘤染色，结合病变的囊性表现，符合ABC。
用聚乙烯醇颗粒选择性栓塞病变的供血动脉。需要进行三次栓塞才能完全消除病变的血供。
在颅颈交界区完全手术切除ABCs，由于这些病变的高血管性和破坏性，可能会导致较高的并发症发生率。本文讨论的病例证明了选择性动脉栓塞作为主要的独立治疗方式的可行性。
