Nationwide Children's Hospital is unique in treating aneurysmal bone cysts because we have the world’s largest experience in minimally-invasive treatment of these cysts. The diagnostic and treatment breakthroughs our team has made have converted clinical experiences for patients with aneurysmal bone cyst from those of frustration and uncertainty to expectations of precise planning and treatment. All with predictable healing and healthy outcomes. With over 300 treatments as of August 2013, Nationwide Children's Hospital has successfully treated 100% of our aneurysmal bone cyst patients, all returning to normal activity, healthy daily function, and without negative complications.
If you, or your child, have been diagnosed with aneurysmal bone cyst and want to pursue minimally invasive treatment, call our Interventional Coordinator at (614) 722-2375 to set up a consultation with an Interventional Radiologist. You may also request an appointment using our online form.
Dr. Shiels dedicated his life to advancing the field of radiology in order to provide the best care to children in our community, across the country and around the world. As we remember and celebrate his work, we will remain ever-grateful for his passionate mentorship of our radiology team and staff – some of whom have worked side by side with Dr. Shiels for more than a decade. Everything Dr. Shiels learned over his career, he taught to and instilled in his staff including his revolutionary advancements in interventional radiology and ultrasound; treating lymphatic malformations; bone tumor ablation, aneurysmal bone cyst and salivary gland ablation. His passion inspires the entire team to continue delivering the best possible care to children everywhere and his legacy will live in the advancements we continue to make here at Nationwide Children’s.
Aneurysmal bone cysts have unique surgical challenges, often with large amounts of blood loss during surgery, and recurrence following surgical management in 12 to 75 percent of cases (75 percent in children under age 5 years). These therapeutic challenges led our Radiology Team to develop minimally-invasive diagnostic and treatment solutions, in conjunction with the Department of Orthopedic Oncology in The Ohio State University Wexner Medical Center. In the past, the treatment for these cysts relied on surgical curettage (scraping) of the bone cysts with bone graft placement, or amputation if there is recurrence after the scraping.
When designing therapy for aneurysmal bone cysts, our radiologists took the following into consideration. The ideal therapy would kill the solid tumor (fibroproliferative stromal) cells, inhibit or kill the giant cell-like osteoclasts, inhibit angiogenesis (VEGF activity), inhibit the destructive enzymes known as MMP (matrix metalloproteinase), and trigger the body to heal the affected bone with new bone. The interventional radiology treatment of aneurysmal bone cyst involves a series (one every 3 months) of treatment injections of a drug known as doxycycline (injected as a foam). The therapy is usually performed an outpatient procedure with minimal recovery time and often also relieves the bone pain produced by the cyst. The treatment injections are precisely guided with either ultrasound "cameras", live X-ray machines (fluoroscopy), or CT scan. The doxycycline is injected in a sustained-released form that prolongs the therapeutic effect of treatment and prevents rapid washout of the drug in the aneurysmal bone cyst tissue and vascular spaces. After precise injection of the doxycycline foam, the openings of the bones are sealed as the needles are removed. Finally, numbing medicine (a local anesthetic) is injected in the tissues surrounding the needle entry sites to reduce pain from the procedure.
Above: patient undergoing aneurysmal bone cyst treatment at Nationwide Children's Hospital
Since the treatment involves placing needles precisely into the bone with the aneurysmal bone cyst, the procedure is performed while the patient is asleep with general anesthesia.
Each aneurysmal bone cyst treatment session lasts approximately 1 hour.
Risks are possible with any treatment but are extremely rare. In over 300 treatments at Nationwide Children’s Hospital, there have been no complications of infection, excessive bleeding, or injury to muscles, nerves, or other nearby body parts. The possibility of skin injury at the injection site is minimized by precise pressure control during the treatment injection procedure.
Once the patient is awake from anesthesia, the patient is discharged as an outpatient and sent home. Patients are able to move normally the same day following each treatment without special recovery time. Patients are given a prescription for pain medication if the treatment site hurts for a day or two.
Patients may shower immediately following treatment but are asked not to submerge the treatment parts in a bathtub for a few days.
There are no specific activity restrictions (other than those prescribed by your orthopedic surgeon or neurosurgeon prior to treatment). Patients are instructed to be careful not to engage in strenuous activity with the affected bone to avoid fracture of the bone while it is healing.
Since the cyst contains many small and large spaces with tumor cells, patients are followed for 5 years after treatment is completed. During this 5-year period, the radiologists at Nationwide Children's Hospital monitor for evidence of small islands of tumor cells that did not get killed during initial treatment. If small areas of residual tumor are detected, with small enlarging areas of bone loss, the interventional radiologists precisely target treatment of these remaining areas of tumor tissue. This type of residual tumor detection is considered recurrence and occurs in approximately 5% of patients. Once these final islands of tumor cells are treated, no cases of recurrence have occurred in the 8 years of treatment at Nationwide Children's Hospital.
All children with aneurysmal bone cysts next to their growth plates have demonstrated healing of the cysts and normal growth of adjacent bone, with no injury to the bone growth plate. In a small number of patients (2%), when the cyst invades the growth plate of the bone, the treatment and healing process results in a bone scar in this area that can result in a growth disturbance of the bone and mild shortening of the affected bone. No other negative long-term effects have been identified in 8 years of ABC treatment at Nationwide Children's Hospital. None of the patients (some treated after surgical recurrence) have required surgery for further treatment. All of the patients have normal use of the affected bones, including normal motion and activity, including the spine after treatment of spinal aneurysmal bone cyst. None have had a spinal fusion, which is permanent immobilization using metal rods, screws and a bone graft.
If an aneurysmal bone cyst is left untreated, the destructive tumor processes in the bone continues. Further bone destruction will cause pain, fracture of the bone, immobility of the patient, and if the cyst involves the spine, further destruction can result in nerve damage or paralysis.
A 17-year-old girl, who was succeeding in high school both socially and academically, began suffering with frequent neck pain and headaches. She was able to push through her pain until it became increasingly worse when she tilted her head to the left. A CT scan showed an aneurysmal bone cyst with complete destruction of the left half of her second cervical vertebra and no bony protection over the spinal cord in this dangerous location. A neurosurgeon described the most optimistic surgical option, which included extensive surgery, to remove the diseased bony segment in this highly sensitive location, and permanent spinal fusion, with hope for no recurrence. The neurosurgeon recommended a second opinion consultation at Nationwide Children’s Hospital. After considering the interventional radiology plan for definitive biopsy and treatment, and evaluating prior results at Nationwide Children’s Hospital, the neurosurgeon, patient and her parents elected to proceed with the minimally-invasive interventional radiology biopsy and treatment. Four years following a series of 4 outpatient treatments, the patient’s neck has fully healed with strong bone fully protecting her spinal cord. She has full mobility and use of her neck, without recurrence of her aneurysmal bone cyst tumor.
Personally trained by Dr. Shiels, James Murakami, MD, MS, will be carrying on the care of Dr. Shiels' patients. A faculty member at Nationwide Children's for more than 15 years, Dr. Murakami has interventional radiology interests focusing on sclerotherapy of vascular malformations and benign cysts of the head and neck, orbits, and bones.