F Batisse1, A Schmitt2, T Vendeuvre3, D Herbreteau4, C Bonnard5. 1. Service de chirurgie orthopédique et traumatologie, CHU de Poitiers, 1, rue de la Milétrie, 86021 Poitiers, France. Electronic address: francoisbatisse@hotmail.com. 2. Service de chirurgie orthopédique et traumatologie infantile, université F.-Rabelais, CHU de Tours, hôpital de Clocheville, boulevard Béranger, 37044 Tours, France. Electronic address: antoine.schmitt@etu.univ-tours.fr. 3. Service de chirurgie orthopédique et traumatologie, CHU de Poitiers, 1, rue de la Milétrie, 86021 Poitiers, France. Electronic address: t.vendeuvre@gmail.com. 4. Service de neuroradiologie, université F.-Rabelais, CHU de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France. Electronic address: denis.herbreteau@univ-tours.fr. 5. Service de chirurgie orthopédique et traumatologie infantile, université F.-Rabelais, CHU de Tours, hôpital de Clocheville, boulevard Béranger, 37044 Tours, France. Electronic address: c.bonnard@chu-tours.fr.
Abstract
INTRODUCTION: Sclerotherapy offers an alternative to surgery for the treatment of aneurysmal bone cyst (ABC). The main objective of the present study was to assess the radiological efficacy of sclerotherapy in terms of ossification on MRI. Secondary objectives were to assess clinical efficacy on pain evaluation and to analyze recurrence and complications according to type of sclerosing agent and intraoperative imaging technique. MATERIALS AND METHODS: Between 2006 and 2014, 19 patients (7 females, 12 males, aged 3 to 17 years) with ABC treated by sclerotherapy were included. Six received Ethibloc(®), 9 Aetoxisclerol(®), 2 liquid absolute alcohol, and 2 absolute alcohol gel. Assessment used fluoroscopy in 17 cases and CT in 2. Ossification was assessed on MRI and pain on a visual analog scale and HEDEN score. RESULTS: Ossification was complete in 11 cases (84.6%) and partial in 2 (15.4%). Eighteen patients (94.7%) were pain-free at 3 months. There was no recurrence, at a minimum 2 years' follow-up. One case of skin necrosis was observed, associated with use of liquid absolute alcohol; there was 1 case of arterial reflux of Ethibloc(®) under CT control. DISCUSSION: Sclerotherapy enables minimally invasive treatment of lesions that are deep, difficult of access to surgery and potentially damaging. Use of absolute alcohol gel and fluoroscopic control seems to improve the risk/benefit ratio, limiting complications by vascular extravasation of the sclerosing agent, thanks to real-time visualization of diffusion. Its clinical and radiological efficacy makes sclerotherapy and alternative primary treatment choice in ABC. LEVEL OF EVIDENCE: IV, retrospective study.
INTRODUCTION: Sclerotherapy offers an alternative to surgery for the treatment of aneurysmal bone cyst (ABC). The main objective of the present study was to assess the radiological efficacy of sclerotherapy in terms of ossification on MRI. Secondary objectives were to assess clinical efficacy on pain evaluation and to analyze recurrence and complications according to type of sclerosing agent and intraoperative imaging technique. MATERIALS AND METHODS: Between 2006 and 2014, 19 patients (7 females, 12 males, aged 3 to 17 years) with ABC treated by sclerotherapy were included. Six received Ethibloc(®), 9 Aetoxisclerol(®), 2 liquid absolute alcohol, and 2 absolute alcohol gel. Assessment used fluoroscopy in 17 cases and CT in 2. Ossification was assessed on MRI and pain on a visual analog scale and HEDEN score. RESULTS: Ossification was complete in 11 cases (84.6%) and partial in 2 (15.4%). Eighteen patients (94.7%) were pain-free at 3 months. There was no recurrence, at a minimum 2 years' follow-up. One case of skin necrosis was observed, associated with use of liquid absolute alcohol; there was 1 case of arterial reflux of Ethibloc(®) under CT control. DISCUSSION: Sclerotherapy enables minimally invasive treatment of lesions that are deep, difficult of access to surgery and potentially damaging. Use of absolute alcohol gel and fluoroscopic control seems to improve the risk/benefit ratio, limiting complications by vascular extravasation of the sclerosing agent, thanks to real-time visualization of diffusion. Its clinical and radiological efficacy makes sclerotherapy and alternative primary treatment choice in ABC. LEVEL OF EVIDENCE: IV, retrospective study.
Authors: Nils Deventer; Martin Schulze; Georg Gosheger; Marieke de Vaal; Niklas Deventer Journal: Cancers (Basel) Date: 2021-05-14 Impact factor: 6.639