The Role of Preoperative Embolization in the Management of Aneurysmal Bone Cyst: A Comparative Analysis.

Introduction: The aim of this study was to evaluate the role of preoperative embolization in the management of aneurysmal bone cysts. Methods: In this study, the data of a total of 19 patients, 11 females and 8 males, with a mean age of 19.6 (range 5-46 years), who were operated on in our hospital with the diagnosis of ABC between January 2015 and January 2021 were retrospectively analyzed. In the specified date range, there were 10 patients with a diagnosis of ABC who were operated on within 48 h after preoperative embolization. For statistical comparison, 9 patients who were operated on without embolization in the same date range were included as the control group. Results: The mean age of the study group was 16.7 (between 5 and 27 years), while the mean age of the control group was 22.6 (between 16 and 46 years). In the embolization group (group I), the mean intraoperative blood loss was 550 mL (100-1200 mL), the mean intraoperative blood transfusion was 270 mL (0-900 mL), and the mean surgical time was 85 min. In the non-embolization group (group II), the mean intraoperative blood loss was 1250 mL (600-2200 mL), the mean intraoperative blood transfusion was 450 mL (450-1800 mL), and the mean surgical time was 90 min. In comparison, a statistically significant difference was found between the embolization group and the non-embolization group in terms of blood loss and blood transfusion requirement (p = 0.011 and p = 0.017, respectively). The mean surgery time was slightly shorter in the embolized group, and there was no significant difference in surgical time between the two groups (p = 0.821). Conclusion: Evidence suggests that preoperative embolization of an aneurysmal bone cyst, performed 0-48 h before surgery, can result in a reduction in intraoperative blood loss and intraoperative blood transfusion volume.

Does the preoperative neutrophil-to-lymphocyte ratio have a prognostic value in aneurysmal bone cysts?

OBJECTIVES: The aim of this study was to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-tomonocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in aneurysmal bone cysts (ABCs). PATIENTS AND METHODS: Between February 2001 and August 2019, a total of 86 patients (44 males, 42 females; mean age: 21.5±15.2 years; range, 2 to 73 years) with a histologically confirmed diagnosis of ABCs who did not receive cancer treatment previously and had a minimum follow-up period of 24 months were retrospectively analyzed. Data including age, sex, side, tumor location, pre-treatment complete blood count analysis results, preferred surgical method, follow-up period, presence of recurrence, and date of recurrence were recorded. Preoperative NLR, LMR and PLR values were calculated in all patients. RESULTS: The mean follow-up was 56.7±13.5 (range, 24 to 179) months. Forty-one (47.7%) ABCs were located in the lower extremities, 36 (41.8%) in the upper extremities, and nine (10.4%) in the pelvic girdle. A statistically significant difference was detected in the NLR values according to recurrence status (p=0.023). The PLR and LMR values were not significant for area under the curve, while NLR values were significant for recurrence. The cut-off value was determined as 2.054. Those with an NLR of ≥2.054 were found to have a 4.561-fold higher risk of recurrence than those with an NLR of <2.054 (odds ratio [OR]=4.561). CONCLUSION: Our study results suggest that NLR, which is the pre-treatment inflammatory index, is a prognostic factor in patients with ABCs. Although NLR alone is not decisive in patients with elevated NLR, it can be used to evaluate the clinical prognosis and recommend an appropriate treatment strategy.

Clinical outcomes of tumors and tumor-like lesions located in the clavicle.

OBJECTIVES: The aim of this study was to examine the characterization of tumors and tumor-like lesions located in the clavicle and to present their clinical results. PATIENTS AND METHODS: Between January 2006 and December 2018, a total of 44 patients (25 males, 19 females; mean age: 36.2±21.8 years; range, 2 to 87 years) who were operated in our clinic for a clavicular lesion were included. Among 4,856 extremity tumors operated in our clinic between these years, 44 cases (0.9%) located in the clavicle were eligible. Demographic data, tumor types, location, surgical method, metastasis, survival analyzes and clinical results of these patients were reviewed retrospectively. According to the clavicle location, the patients were divided into groups according to their involvement in proximal, middle, lateral and more than one region. RESULTS: The most frequently involved site was the lateral edge of the clavicle, and the most common tumor was aneurysmal bone cyst. The most common malignant tumor was Ewing sarcoma and plasmacytoma (13.6%) and the most common surgical method in the clavicle was wide resection with 34.1%. Of the 38 primary clavicle tumors remaining after the metastatic lesions were removed, 21 (55%) were benign, while 17 (45%) were malignant. Aneurysmal bone cyst was most common in the group under 30 years of age, osteochondroma was most common in the 30-50 age group, and plasmacytoma was most common in those over 50 years of age. The mean musculoskeletal tumor society (MSTS) score of 15 patients (34.1%) who underwent clavicle resection was 79.4±6. CONCLUSION: We believe that a wide spectrum should be considered in the differential diagnosis of tumors located in the clavicle. Age is an important predictive factor for malignancy. We believe that resection should be applied without fear considering its effects on function and recurrence.