Rossi Giuseppe, Mavrogenis Andreas F, Papagelopoulos Panayiotis J, Rimondi Eugenio, Ruggieri Pietro
Department of Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
Orthopedics. 2012 Jun;35(6):e963-8. doi: 10.3928/01477447-20120525-43.
Intralesional surgery is most commonly used for aneurysmal bone cysts. Rarely is en bloc resection used for active, aggressive, recurrent lesions and those located in expendable bones. However, persistence or recurrence of aneurysmal bone cysts is common. The clinical behavior of aneurysmal bone cysts is more aggressive in younger patients. Selective embolization is used as the primary treatment for aneurysmal bone cysts in surgically difficult anatomical locations and as an adjuvant to surgical treatment to reduce intraoperative blood loss and facilitate curettage.This article describes a 3-year-old boy with an aggressive aneurysmal bone cyst of the pelvis involving the right ischiopubic rami that achieved curative treatment with 3 embolizations with N-2-butyl-cyanoacrylate. Biopsy was diagnostic; however, the clinical course was misleading. Twenty days after the first embolization, despite complete occlusion of the feeding vessels, the patient experienced severe pain, increased size of the lesion, and lateral subluxation of the right hip. Based on the imaging and histological diagnosis, intralesional hemorrhage was assumed, and repeat embolization was performed. After the second embolization, the patient experienced perineal skin necrosis from normal vessel embolization; it was treated with wound dressing changes and healed uneventfully. A third embolization was performed because of a persistent lesion. Six years after treatment, the patient was symptom free, and imaging showed complete ossification of the cyst.Selective catheterization and occlusion of the feeding arteries with the appropriate embolic agent provide tumor devascularization, size reduction, pain relief, and induction of new bone formation. Multiple procedures are often necessary, and complications may occur.
病灶内手术最常用于骨动脉瘤样囊肿。对于活跃、侵袭性、复发性病变以及位于可牺牲骨的病变，很少采用整块切除。然而，骨动脉瘤样囊肿的持续存在或复发很常见。骨动脉瘤样囊肿在年轻患者中的临床行为更具侵袭性。选择性栓塞用于手术难度较大的解剖部位的骨动脉瘤样囊肿的主要治疗，以及作为手术治疗的辅助手段以减少术中失血并便于刮除。本文描述了一名3岁男孩，患有累及右耻骨坐骨支的骨盆侵袭性骨动脉瘤样囊肿，通过用N-2-丁基氰基丙烯酸酯进行3次栓塞实现了治愈性治疗。活检具有诊断意义；然而，临床病程具有误导性。首次栓塞后20天，尽管供血血管完全闭塞，但患者仍经历严重疼痛、病变大小增加以及右髋关节外侧半脱位。基于影像学和组织学诊断，推测为病灶内出血，并进行了重复栓塞。第二次栓塞后，患者因正常血管栓塞出现会阴皮肤坏死；通过伤口换药治疗，愈合顺利。由于病变持续存在，进行了第三次栓塞。治疗6年后，患者无症状，影像学显示囊肿完全骨化。用合适的栓塞剂进行选择性插管和供血动脉闭塞可使肿瘤去血管化、缩小尺寸、缓解疼痛并诱导新骨形成。通常需要多次手术，且可能发生并发症。
