Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
5 (
1
); 58-58

Commentary

Department of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy

Address for correspondence: Dr. Giannantonio Spena, Department of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy. E-mail: giannantonios@hotmail.com

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Aneurysmal bone cysts (ABC) of the spine are rare benign tumor that can create several problems in terms of severe pain, deformity, neurological deterioration. Treatment options include intralesional curettage, complete excision, embolization, radiation therapy, intracystic injection of calcitonin and methylprednisolone and combination of these. Surgery is mandatory when the mass compresses the neural structures or destroys the integrity of the vertebrae. A total excision is coupled with higher and stable rate of cure. Complete resection of the lesion means the entire cyst walls and spongy tissues that are lined with hypervascular membrane.[1] Actually, relapses are better defined as continued progression of residual disease left behind by the incomplete treatment rather than regrowth of lesions. The aggressive surgical strategy implies that destroyed spinal segment must be in some way replaced or spinal stability restored.[23] In those cases where ABC are diagnosed incidentally or are of little volume, a watchful wait can be an option reserving the treatment to those who expand rapidly. In some other cases, an intracystic injection of different substances can lead to an ossification of the mass and to an arrest of the growth.[4]

This paper from Joaquim et al.,[5] illustrates well 2 rare cases of aneurysmal bone cysts (ABC) of the craniocervical region. Apart from the rarity of this occurrence, the authors have to be congratulated for the brilliant management of these two complex cases in a relatively low-resources environment. In fact, the highly vascular structure of ABC makes surgical extirpation particularly dangerous since intraoperative blood loss can be fatal, especially in pediatric patients’ nature. That's why intraarterial embolization is strongly desired, when feasible, in order to devascularize the mass. However, ABC are insidious in their clinical presentation and in their natural history as well. Actually, the more these tumors arise in complex location and with large volumes, the more the risks of relapse and/or spinal deformation are around the corner. In the current case number 2, the involvement of the occipital condyle made resection for sure more troublesome. Moreover, the necessity to drill the condyle away for achieving total resection puts into question the need for an occipito-cervical fixation. Rightly, the authors propose to strictly follow-up the patient in order to rule out a progressive craniocervical instability. As our rule, we have the attitude to consider the persistent neck pain as a sign of instability even in absence of radiological misalignment. Still, it's my opinion that fusing the occipito-cervical junction during the first surgery would have avoided the risks for the second surgery vertebral artery dissection that could be embedded in hard scar tissue.

References

  1. , , , , . Surgical management of aneurysmal bone cysts of the spine. Neurosurg Focus. 2003;15:E4.
    [Google Scholar]
  2. , , , , , , . Aneurysmal bone cyst of the mobile spine: Report on 41 cases. Spine. 2001;26:27-35.
    [Google Scholar]
  3. , , . Aneurysmal bone cyst: Concept, controversy, clinical presentation, and imaging. AJR AJR Am J Roentgenol. 1995;164:573-80.
    [Google Scholar]
  4. , , , , , . Aneurysmal bone cyst at C2. Imaging evaluation after intralesional injection of calcitonin and methylprednisolone. Arq Neuropsiquiatr. 2008;66:711-5.
    [Google Scholar]
  5. , , , , . Aneurysmatic bone cysts of the craniocervical region – surgical technique. J Neurosci Rural Pract. 2014;5:55-8.
    [Google Scholar]

    Fulltext Views
    380

    PDF downloads
    229
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections