Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
Eur Spine J. 2013 Mar;22(3):523-31. doi: 10.1007/s00586-012-2548-9. Epub 2012 Oct 31.
Despite numerous descriptive publications, the nature, character, differential diagnosis and optimal treatment of aneurysmal bone cysts (ABCs), remain obscure. The authors report a case of the solid variant of aneurysmal bone cyst (S-ABC) occurring in the posterior components and body of C7 vertebra focusing on the differential diagnosis and surgical treatment rationale.
Right shoulder and neck pain were the presenting symptoms of 9-year-old boy. Torticollis developed later on but no neurological deficit was found. Imaging revealed an osteolytic lesion with significant extraosseous extension. Although diagnosis favoured an ABC, imaging studies did not provide clear diagnostic criteria. CT guided biopsy performed preoperatively was also not directly diagnostic. Given that differential diagnoses included S-ABC but also giant cell tumor (GCT) of bone, decision was made to proceed with a staged, back and front, complete resection of the affected bony elements of C7. Preoperative spinal angiography showed supply to the tumor from the right ascending and deep cervical artery territories. Particle embolization was not performed due to the presence of ipsilateral supply to the anterior spinal artery at the C6 level and contralateral supply at the C7 level. Intraoperatively, histology taken from posterior elements, although again not clearly diagnostic, favoured S-ABC variant rather than GCT. Thus, initial plan was revised and anterior surgery was postponed as the extent of the dissection would have been dependent on the presumed diagnosis. The final histological report confirmed the diagnosis of an S-ABC. In view of this, it was decided to embolize the lesion to avoid a second stage anterior surgery. At embolization, repeat spinal angiography showed reduced tumor blush following the surgery. Distal branches of the deep cervical artery were occluded with platinum coils (avoiding the risks associated with the use of particles or liquid embolic agents). No further procedure was planned.
Imaging and histological pattern of this specific type of ABC, differential diagnosis from GCT and the surgical protocol followed with the patient consist of an interesting case of revising the initial plan, according to the upcoming histological reports.
尽管有大量描述性出版物，但动脉瘤样骨囊肿（ABC）的性质、特征、鉴别诊断和最佳治疗方法仍不清楚。作者报告了一例发生在 C7 椎体后柱和体部的骨样型动脉瘤样骨囊肿（S-ABC）病例，重点介绍了鉴别诊断和手术治疗的原理。
9 岁男孩的首发症状为右肩和颈部疼痛，随后出现斜颈，但无神经功能缺损。影像学检查显示为溶骨性病变，伴有明显的骨外扩展。尽管诊断倾向于 ABC，但影像学检查未提供明确的诊断标准。术前 CT 引导下活检也不能直接诊断。由于鉴别诊断包括 S-ABC，但也包括骨巨细胞瘤（GCT），因此决定分阶段从前、后两个方向完全切除 C7 受累的骨结构。术前脊髓血管造影显示肿瘤的供血来自右侧升颈动脉和深部颈动脉区域。由于 C6 水平存在同侧供应前脊髓动脉和 C7 水平存在对侧供应，因此未进行颗粒栓塞。术中取自后柱的组织学检查虽然仍不明确，但倾向于 S-ABC 变体而不是 GCT。因此，最初的计划被修改，前侧手术被推迟，因为手术的范围将取决于假定的诊断。最终的组织学报告证实了 S-ABC 的诊断。鉴于此，决定对病变进行栓塞以避免二期前路手术。栓塞时，重复脊髓血管造影显示手术后肿瘤染色减少。用铂金线圈闭塞深部颈动脉的远端分支（避免使用颗粒或液体栓塞剂的相关风险）。未计划进一步治疗。
这种特定类型的 ABC 的影像学和组织学模式、与 GCT 的鉴别诊断以及根据即将到来的组织学报告制定的手术方案，构成了一个有趣的病例，需要修改初始计划。
