Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

Clinical outcome after surgery on schwannomas in the extremities

BACKGROUND Schwannoma is a benign,encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system.Typical symptoms are soreness,radiating pain and sensory loss combined with a soft tissue mass.AIM To evaluate pre-and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.METHODS In this single center retrospective study design,all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included.The location of the tumor in the extremities was divided into five groups;forearm,arm,shoulder,thigh and leg including foot.The locations of the tumor in the nerves were also categorized as either;proximal,distal,minor or major nerve.During the pre-and postoperative clinical evaluation,symptoms were classified as paresthesia,local pain,radiating pain,swelling,impairment of mobility/strength and asymptomatic tumors that were found incidentally(with magnetic resonance imaging).The patients were evaluated after surgery using the following categories:Asymptomatic or symptomatic patients(radiating and/or local pain)and those with complications.The follow up period was from the time of surgery until last examination of the particular physician.Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.RESULTS We identified 858 cases from the institutional pathology register.We excluded cases with duplicate diagnoses(n=407),pathology not including schwannomas(n=157),lesions involving the torso,spine and neck(n=150)leaving 144 patients for further analysis.In this group 99 patients underwent surgery and there were five complications recorded:2 infections(treated with antibiotics)and 3 nerve palsies(2 involving the radial nerve and one involving the median nerve)that recovered spontaneously.At the end of follow-up,1.4 mo(range 0.5-76)postoperatively,we recorded a post-operative decrease in clinical symptoms:Local pain 76%(6/25),radiating pain 97%(2/45),swelling 20%(8/10).Symptoms of paresthesia increased by 2.8%(37/36)and there was no change in motor weakness before and after surgery 1%(1/1).Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves(odds ratio:2.63;confidence intervals:1.22-6.42,P=0.029).One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor.No local recurrences were reported.CONCLUSION Surgery of schwannomas can be conducted with low risk of postoperative complications,acceptable decrease in clinical symptoms and risk of malignant transformation is low.