Treatments for Aneurysmal Bone Cyst in Children

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We know how stressful a diagnosis of an aneurysmal bone cyst can be, both for your child and for your whole family. That's why Boston Children's Hospital's physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals who are committed to supporting all of your family's physical and psychosocial needs. We'll work with you to create a care plan that's best for your child.  

Your child's physician will determine a specific course of treatment based on several factors, including: 

   •    your child's age, overall health and medical history
   •    the location of the cyst
   •    the risk of fracture
   •    whether the cyst has recurred 

Why do the aneurysmal bone cysts need to be removed?
Aneursymal bone cysts expand and deform the involved bone. In some cases, this can lead to damage to joints or pathological fracture (a fracture that occurs without trauma). They also cause pain and swelling around the site of the cysts and do not generally go away on their own. To prevent permanent damage to the bone, surgery is needed to cure these cysts. 

What are the treatment options for aneurysmal bone cysts?
Treatment options vary greatly, depending on your child's situation. Your doctor and other members of your care team will discuss the options with you in-depth. 

There is potential for excessive blood loss during an operation to remove aneurysmal bone cysts because of the abnormal blood vessels that may be involved. As a result, surgery involves very careful planning.

Before we decide to do surgery: 

   •    A radiologist may perform a procedure called arterial embolization. This blocks the blood flow in the abnormal
        vessels that are involved with the cyst. This reduces the risk of excessive bleeding during surgery.
   •    To determine whether your child can undergo arterial embolization without complications, your doctor may use
        an angiogram, a special x-ray that allows doctors to visualize the involved blood vessels.

Traditional treatments for aneurysmal bone cysts

Treatment for the cyst will likely involve one or more of the following surgeries performed by a pediatric orthopedic surgeon: 

Curettage and bone grafting
The most common treatment for an aneurysmal bone cyst, this is an operation during which the cyst is scraped out of the bone with a special instrument called a curette that has a scoop, loop or ring at its tip. The procedure itself is called curettage.

The remaining cavity is then packed with donor bone tissue (called an allograft), bone chips taken from another bone (autograft) or other materials. 

Extended curettage
In some cases, Children's orthopedic surgeons perform an “extended” curettage using a special instrument (a curette) to remove additional layers of cells around the bone cyst. This is simply a more aggressive type of the procedure described above. It is done to reduce the risk that the cyst will grow back. 

Marginal or wide excision
This operation removes the part of the bone involving the cysts at its margins or beyond its margins (known as a wide excision). A wide excision is recommended when the cyst is located in bones considered expendable, such as the ribs or fibula. It is avoided whenever possible when the cyst occurs in a location that could compromise the bone's function. 

This is a promising non-surgical technique for healing aneurysmal bone cysts. Instead of surgery to remove the cyst, doctors inject special chemicals into the cyst in order to promote the creation of scar tissue. This scar tissue eventually heals and hardens into bone, healing the cyst without the need for an open surgery. 

Because it's possible that the cyst will grow back, this procedure, which surgically freezes the cyst, is sometimes used in addition to curetting and bone grafting. However, it is associated with complications such as fracture of the bone, nerve injury and others.

Recurrence and long-term care

How often do aneurysmal bone cysts recur?
Aneurysmal bone cysts return about 20 percent of the time. To treat cysts that return, Children's doctors provide follow-up care for every three months for the first two years after treatment.

Recurrent aneurysmal bone cysts are treated using the same techniques, although your child's orthopedic surgeon may opt for a more aggressive treatment to prevent further recurrence. 

What is the recommended long-term care for children treated for aneurysmal bone cysts?Patients treated for aneurysmal bone cysts should return to Children's for frequent follow-up visits to:

   •    manage disease complications
   •    screen for early recurrence of the cyst

A typical follow-up visit may include all of the following: 

   •    a physical exam
   •    a thorough history
   •    imaging scans (such as x-rays)

Will my child be OK in the long term?
Children with aneurysmal bone cysts usually have very good long-term health, although the condition can recur. Patients may become frustrated, because this benign cyst can return after surgery.

It may require two or three operations to eventually get rid of the cyst, but ultimately, this is a benign tumor and it does not spread. If left untreated, these cysts can cause pain, swelling and permanent damage to the bone as well as an increased risk of pathological fracture. 

Coping and support

In addition to providing exceptional medical care, Children's strives to also meet all of your family's emotional and quality-of-life needs. We know that unfamiliar places, especially hospitals, often create anxiety and fear for a child. 

We also know this isn't an easy time or task for parents, who have their own fears and concerns about the situation. Our family support services will help address many of your needs and concerns.

Read about our resources and support services .

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

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