Aneurysmal bone cysts abutting the growth plate: evaluation of the impact of alcohol sclerotherapy.

BACKGROUND

Aneurysmal bone cysts (ABCs) are benign bone lesions frequently observed in children and adolescents. These cysts can form in any part of the skeleton and are characterized by fluid-filled cavities surrounded by fibrous tissue.

OBJECTIVE

This study aims to evaluate the efficacy and safety of interventional radiology treatment by intra-cystic alcohol sclerotherapy of ABCs abutting the growth plate in pediatric patients.

MATERIALS AND METHODS

A retrospective study was conducted across two hospital centers between January 2012 and June 2022. The study included patients diagnosed with ABCs abutting the growth plate and treated via intra-cystic alcohol sclerotherapy. The radiographic diagnosis of ABCs was confirmed using radiographs and magnetic resonance imaging (MRI), and a biopsy was performed for definitive confirmation. The patients were followed up for a minimum of 12 months post-alcohol sclerotherapy.

RESULTS

A total of 14 patients were included in the study, with 13 active ABCs and one aggressive ABC, based on the Capanna classification. The mean clinical and radiological follow-up after sclerotherapy was 36.1 months ± 17.4 months. No epiphysiodesis was reported in any of the patients. At least 1 year after the procedure, 13 of the 14 patients did not present any pain; 12 of 14 patients did not require surgery; one patient presented with a fracture; and one presented with asymmetry of the lower limbs after surgery. New bone formation and/or increased cortical thickness were considered major in three ABCs (score I on the modified Neer classification) and significant in nine ABCs (score II on the modified Neer classification).

CONCLUSION

Alcohol sclerotherapy of active ABCs abutting the growth plate shows no short-term complications and poses no risk of epiphysiodesis. This suggests that alcohol sclerotherapy could be a safe and effective treatment option for ABCs abutting the growth plate in pediatric patients.

CLINICAL IMPACT

This study supports alcohol sclerotherapy as a minimally invasive, safe, and effective treatment for pediatric ABCs near the growth plate, potentially reducing the need for surgical interventions.