Abstract

Surgically accessible aneurysmal bone cysts (ABC) have traditionally been treated with curettage. Selective arterial embolization was initially proposed as a preoperative adjuvant to reduce peroperative bleeding. Currently, the role of embolization has been extended to the definitive treatment of aneurysmal bone cyst of the spine in children, as well as to other locations in the skeleton. The authors describe the technique in a 15-year-old girl with a T2 aneurysmal bone cyst. Digital subtraction angiography was performed for tumor vascular mapping, followed by selective arterial embolization with N-butyl 2 cyanoacrylate (NBCA). Because of persistent local pain, repeat embolization was done at 8 months. Pain relief and progressive ossification of the lesion were now observed. At 4-year follow-up, the patient was asymptomatic, with complete ossification of the lesion. Selective arterial embolization (SAE) is a minimally invasive, safe and effective procedure for the permanent occlusion of the pathological feeding vessels of spinal ABC. It should be considered as the treatment of choice for lesions difficult to access with surgery, especially in young patients. Careful pre-embolization vascular mapping of the lesion, operator's experience and use of NBCA are the keys to success.