Aneurysmal bone cysts abutting the growth plate: evaluation of the impact of alcohol sclerotherapy.
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BACKGROUND: Aneurysmal bone cysts (ABCs) are benign bone lesions frequently observed in children and adolescents. These cysts can form in any part of the skeleton and are characterized by fluid-filled cavities surrounded by fibrous tissue. OBJECTIVE: This study aims to evaluate the efficacy and safety of interventional radiology treatment by intra-cystic alcohol sclerotherapy of ABCs abutting the growth plate in pediatric patients. MATERIALS AND METHODS: A retrospective study was conducted across two hospital centers between January 2012 and June 2022. The study included patients diagnosed with ABCs abutting the growth plate and treated via intra-cystic alcohol sclerotherapy. The radiographic diagnosis of ABCs was confirmed using radiographs and magnetic resonance imaging (MRI), and a biopsy was performed for definitive confirmation. The patients were followed up for a minimum of 12 months post-alcohol sclerotherapy. RESULTS: A total of 14 patients were included in the study, with 13 active ABCs and one aggressive ABC, based on the Capanna classification. The mean clinical and radiological follow-up after sclerotherapy was 36.1 months ± 17.4 months. No epiphysiodesis was reported in any of the patients. At least 1 year after the procedure, 13 of the 14 patients did not present any pain; 12 of 14 patients did not require surgery; one patient presented with a fracture; and one presented with asymmetry of the lower limbs after surgery. New bone formation and/or increased cortical thickness were considered major in three ABCs (score I on the modified Neer classification) and significant in nine ABCs (score II on the modified Neer classification). CONCLUSION: Alcohol sclerotherapy of active ABCs abutting the growth plate shows no short-term complications and poses no risk of epiphysiodesis. This suggests that alcohol sclerotherapy could be a safe and effective treatment option for ABCs abutting the growth plate in pediatric patients. CLINICAL IMPACT: This study supports alcohol sclerotherapy as a minimally invasive, safe, and effective treatment for pediatric ABCs near the growth plate, potentially reducing the need for surgical interventions.