Aneurysmal bone cyst of skull and vertebrae in children. Analysis of own material and review of the literature.

Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion, consisting of blood-filled cysts, capable both of rapid enlargement and spontaneous resolution. Asymptomatic cases have been reported too. The aim of this paper was to analyse the outcomes of surgical treatment of ABC in children and a review of pertinent literature. We adopted the method of retrospective analysis of medical documentation of 10 patients with ABC. These were patients at the Department of Neurosurgery of the Children's Memorial Health Institute (Warsaw, Poland) from 1980 to 2002. There were 2 cases of cranial lesions and 8 cases of vertebral lesions. All the patients underwent surgical treatment only. Total lesionectomy was obtained in 7 cases, subtotal--in 3 cases. With the mean follow-up time of 5.1 years, good outcome (no neurological deficits) was noticed in 5 cases, moderate disability in the form of paraparesis--in 4 cases and full paraplegia--in 1 case. The following perioperative complications were noticed: transient paraplegia (1 case) and recurrence of ABC requiring reoperation (1 case). Among the 8 patients with vertebral lesions, progressive scoliosis requiring instrumental stabilization of the spine was noticed in 5 cases (4 vertebral body lesions and 1 laminar lesion). Primaiy infiltration of vertebral body by an ABC may lead to subsequent progressive scoliosis, which requires instrumental stabilization of spine. This demands careful planning and development of a comprehensive treatment program. ABC in children is a predominantly aggressive lesion, but even subtotal excision does not entrain a recurrence. Localization of lesion at the D3-5 levels is associated with an increased risk of postoperative neurological deterioration. Patients should be treated surgically before the development of severe deficits, which later may prove irreversible.