Campanacci and colleagues compared curettage with cortisone injection for unicameral bone cysts, and proposed a radiographic grouping of aneurysmal bone cysts, the Campanacci classification of aneurysmal bone cyst, to guide surgery.
Retrospective Rizzoli review of unicameral cysts (178 grafted, 141 injected) and 198 aneurysmal cysts treated up to 1982, with aneurysmal cysts followed a mean 7 years.
Key Findings
After a first curettage and grafting of 178 unicameral cysts, 46% healed completely and 33% recurred. With repeat operations, 61% ultimately healed completely and 13% recurred.
Of 141 unicameral cysts injected with methylprednisolone, 50% ultimately healed completely, 25% incompletely, 15% recurred and 10% did not respond. The authors judge this comparable to surgery.
After grafting, unicameral cysts touching the growth plate recurred more often, while cyst volume and graft type had no effect. After injection, multilocular, large and active cysts did worse.
After curettage of 91 aneurysmal cysts, 19 (21%) recurred, all of them aggressive or active. No cyst treated by total or partial resection recurred.
Radiotherapy in 23 aneurysmal cysts was followed by recurrence in 5 (22%), and complications included limb shortening, gonadal damage and femoral osteonecrosis.
Spinal aneurysmal cysts can compress the cord or roots, sometimes suddenly from vertebral collapse. Eight of 24 such patients developed paraparesis.
Board pearl
In the authors' view, a limited window is inadequate for active aneurysmal bone cysts. They saucerize the cavity by removing a wide area of wall, and may add phenol or cryosurgery.
Campanacci radiographic types of aneurysmal bone cystCampanacci, Clin Orthop Relat Res 1986
Type I
Central cyst, bone profile intact or slightly and evenly expanded
Type II
Whole segment replaced and severely inflated, mainly in thin long bones
Type III
Eccentric intraosseous cyst with no or minimal cortical expansion
Type IV
Subperiosteal cyst with superficial erosion of the underlying cortex
Type V
Subperiosteal cyst expanding into soft tissue, cortex destroyed into cancellous bone
Authors' conclusion
The treatment of choice in ABC is surgical and the type (curettage, curettage plus phenole or cryosurgery, resection or hemiresection) is selected on the basis of the radiographic aspect and the rate of growth of the cyst. Radiotherapy is only indicated in inoperable ABC cases.
Campanacci and colleagues compared curettage with cortisone injection for unicameral bone cysts, and proposed a radiographic grouping of aneurysmal bone cysts, the Campanacci classification of aneurysmal bone cyst, to guide surgery.
Retrospective Rizzoli review of unicameral cysts (178 grafted, 141 injected) and 198 aneurysmal cysts treated up to 1982, with aneurysmal cysts followed a mean 7 years.
Key Findings
After a first curettage and grafting of 178 unicameral cysts, 46% healed completely and 33% recurred. With repeat operations, 61% ultimately healed completely and 13% recurred.
Of 141 unicameral cysts injected with methylprednisolone, 50% ultimately healed completely, 25% incompletely, 15% recurred and 10% did not respond. The authors judge this comparable to surgery.
After grafting, unicameral cysts touching the growth plate recurred more often, while cyst volume and graft type had no effect. After injection, multilocular, large and active cysts did worse.
After curettage of 91 aneurysmal cysts, 19 (21%) recurred, all of them aggressive or active. No cyst treated by total or partial resection recurred.
Radiotherapy in 23 aneurysmal cysts was followed by recurrence in 5 (22%), and complications included limb shortening, gonadal damage and femoral osteonecrosis.
Spinal aneurysmal cysts can compress the cord or roots, sometimes suddenly from vertebral collapse. Eight of 24 such patients developed paraparesis.
Board pearl
In the authors' view, a limited window is inadequate for active aneurysmal bone cysts. They saucerize the cavity by removing a wide area of wall, and may add phenol or cryosurgery.
Campanacci radiographic types of aneurysmal bone cystCampanacci, Clin Orthop Relat Res 1986
Type I
Central cyst, bone profile intact or slightly and evenly expanded
Type II
Whole segment replaced and severely inflated, mainly in thin long bones
Type III
Eccentric intraosseous cyst with no or minimal cortical expansion
Type IV
Subperiosteal cyst with superficial erosion of the underlying cortex
Type V
Subperiosteal cyst expanding into soft tissue, cortex destroyed into cancellous bone
Authors' conclusion
The treatment of choice in ABC is surgical and the type (curettage, curettage plus phenole or cryosurgery, resection or hemiresection) is selected on the basis of the radiographic aspect and the rate of growth of the cyst. Radiotherapy is only indicated in inoperable ABC cases.