title: Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment?
abstract: BACKGROUND
  Our goal was to assess the effectiveness and safety of argon beam coagulation as an adjuvant treatment for primary aneurysmal bone cysts, to reevaluate the adjuvant effectiveness of the use of a high-speed burr alone, and, secondarily, to identify predictors of aneurysmal bone cyst recurrence.
  
  
  METHODS
  We retrospectively reviewed the records of ninety-six patients with primary aneurysmal bone cysts who were managed at our institution from January 1, 1983, to December 31, 2008. Forty patients were managed with curettage, a high-speed burr, and argon beam coagulation; thirty-four were managed with curettage and a high-speed burr without argon beam coagulation; and the remaining twenty-two were managed with curettage with argon beam coagulation alone, curettage with no adjuvant treatment, or resection of the entire lesion. Demographic, clinical, and radiographic data were viewed comparatively for possible predictors of recurrence. Kaplan-Meier survival analysis with a log-rank test was performed to measure association and effectiveness.
  
  
  RESULTS
  The median age at the time of diagnosis was fifteen years (range, one to sixty-two years). The median duration of follow-up was 29.5 months (range, zero to 300 months). The overall rate of recurrence of aneurysmal bone cyst after surgical treatment was 11.5%. The rate of recurrence was 20.6% after curettage and high-speed-burr treatment alone and 7.5% after curettage and high-speed-burr treatment plus argon beam coagulation. The five-year Kaplan-Meier survival estimate was 92% for patients managed with curettage and adjuvant treatment with a high-speed burr and argon beam coagulation, compared with 73% for patients managed with curettage and a high-speed burr only (p = 0.060).
  
  
  CONCLUSIONS
  Surgical treatment of aneurysmal bone cyst with curettage and adjuvant argon beam coagulation is effective. Postoperative fracture appears to be a common complication of this treatment and needs to be studied further. Treatment with curettage and high-speed burr alone may not reduce recurrence.
authors: University of Chicago Medical Center, Chicago, Illinois, USA. robert.steffner@uchospitals.edu
authors: Robert J
authors: RJ
authors: Steffner
authors: Chuanhong
authors: C
authors: Liao
authors: Gregory
authors: G
authors: Stacy
authors: Alfred
authors: A
authors: Atanda
authors: Samer
authors: S
authors: Attar
authors: Raffi
authors: R
authors: Avedian
authors: Terrance D
authors: TD
authors: Peabody
mesh_terms: D000293:Adolescent; D000328:Adult; D057908:Argon Plasma Coagulation / Q000009:adverse effects / Q000379:methods*; D050280:Arm Bones / Q000000981:diagnostic imaging / Q000601:surgery; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003475:Curettage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007867:Leg Bones / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult