The treatment of aneurysmal bone cyst.

Forty-four patients with aneurysmal bone cysts were treated with curettage with or without bone grafting, and in 26 (59%) recurrence developed. Of 11 patients treated with radiation, in only 1 (9%) the disease was not controlled. In 1 patient, radiation-induced sarcoma developed. Since the introduction of cryosurgery 27 years ago, 51 patients have been treated with cryosurgery. The patients had an average age of 13 years (range, 2-32 years). Thirty-four primary aneurysmal bone cysts and 17 secondary aneurysmal bone cysts occurred in association with 7 giant-cell tumors, 5 chondroblastomas, 2 fibromyxomas, 2 nonossifying fibromas, and 1 unicameral bone cyst. The tumors were classified as inactive in 9 patients, active in 31, and aggressive in 11. Treatment consisted of local intralesional excision followed by application of liquid nitrogen. The defect was either allowed to heal spontaneously (n = 26) or was reconstructed using an intramedullary rod (n = 2), bone grafts (n = 5), fibular strut grafts (n = 14), or polymethylmethacrylate with Steinmann pins (n = 4). At median followup of 85 months (range, 24-311 months), the overall cure rate was 82%. This was increased to 96% after a second, or repeat, cryosurgery. The disease in all patients eventually was controlled by cryosurgery. The mean functional rating was 90% (range, 63%-100%). Intralesional excision with adjunctive cryosurgery is an effective method for the treatment of aneurysmal bone cyst.