Aneurysmal bone cysts in children: complications of fibrosing agent injection.
OBJECTIVE
To report complications of direct fibrosing agent injection in the treatment of aneurysmal bone cysts (ABCs) in children.


METHODS
The authors retrospectively analyzed all cases of ABCs treated with direct fibrosing agent injection (Ethibloc; Ethnor Laboratories, Ethicon, Noderstedt, Germany) at Robert Debré Hospital since 1994. Histologic diagnosis was assigned by means of surgical biopsy findings prior to treatment. Treatment responses were categorized. Injection was administered with general anesthesia, computed tomographic guidance, and use of a 14- to 16-gauge needle. Contrast material was injected to determine presence of intracystic septa and verify absence of venous opacification. Amount of fibrosing agent injected corresponded to amount of contrast material necessary to fully opacify the cyst. Intraosseous needle track was obliterated with histoacryl injection.


RESULTS
Fifteen patients were treated. Mean follow-up was 80 months; no patient was lost to follow-up. One patient experienced pulmonary embolus that necessitated a 7-day intensive care unit stay. Four patients experienced early aseptic fistulization after the first injection, which led to surgical débridement and curettage. Five patients had transient inflammatory reaction with mild 38 degrees C fever, which was controlled with analgesic and antiinflammatory drugs. Eleven patients did not require surgery, and results at latest follow-up were considered to indicate complete healing (type 1 results) in nine and incomplete healing (type 2 results) in two. For type 1 results: Six patients received one injection, two received two injections, and one received three injections. For type 2 results: one patient received one injection, and one received three injections.


CONCLUSIONS
A high rate of major local and general complications was encountered with use of direct fibrosing agent injection; the technique has been abandoned for treatment of ABCs.
Topouchian
Vicken
V
Department of Orthopedic Surgery, Robert Debré Hospital, 48 bd Sérurier, 75019 Paris, France. topouchian.vicken@wanadoo.fr
Mazda
Keyvan
K
Hamze
Bassam
B
Laredo
Jean-Denis
JD
Penneçot
Georges-François
GF
D000293:Adolescent; D001706:Biopsy; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001861:Bone Regeneration / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D003973:Diatrizoate / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging / Q000628:therapy; D005227:Fatty Acids / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D011409:Propylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D015642:Radiology, Interventional; D012008:Recurrence; D019233:Retreatment; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D015911:Sclerotherapy; D014057:Tomography, X-Ray Computed; D015028:Zein / Q000008:administration & dosage / Q000009:adverse effects*
D004338:Drug Combinations; D005227:Fatty Acids; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D003973:Diatrizoate; D015028:Zein; C020481:alcoholic prolamine solution