Aneurysmal bone cyst of the atlas: successful treatment through selective arterial embolization: case report.
OBJECTIVE
Aneurysmal bone cysts (ABCs) are benign and expansile osteolytic lesions that can occur in any location in the spine, including the craniovertebral junction. Aggressive resection followed by bone grafting has been the mainstay of treatment, with selective arterial embolization as a presurgical adjunct. Complete excision of these lesions at the craniovertebral junction is associated with high surgical morbidity. We report a case of successful treatment of an ABC of the atlas in a child with selective arterial embolization alone.


METHODS
A 10-year-old girl presented with persistent neck pain after a snowboarding accident. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansile cystic mass involving the right lateral mass of C1. Digital subtraction angiography revealed a tumor blush, which, along with the cystic appearance of the lesion, was consistent with an ABC.


METHODS
The arterial feeders to the lesion were selectively embolized with polyvinyl alcohol particles. Three sessions of embolization were required to eradicate the blood supply to the lesion completely.


CONCLUSIONS
Complete surgical resection of ABCs at the craniovertebral junction can be associated with high morbidity secondary to the highly vascular and destructive nature of these lesions. The case discussed here demonstrates the viability of selective arterial embolization as a primary and stand-alone modality of treatment.
Mohit
A Alex
AA
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Eskridge
Joseph
J
Ellenbogen
Richard
R
Shaffrey
Christopher I
CI
D017824:Bone Cysts, Aneurysmal / Q000628:therapy*; D001270:Cervical Atlas / Q000098:blood supply*; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans