Outcomes of Percutaneous Cryoablation in Aneurysmal Bone Cysts: A Clinical and Imaging Analysis

To evaluate the clinical and imaging outcomes of percutaneous cryoablation as a minimally invasive alternative for ABCs in both treatment-naïve patients and those with prior treatment failures.

In this retrospective analysis, 41 patients (mean age 13.6 years) with imaging- or biopsy-confirmed ABCs underwent 80 cryoablation procedures between December 2016 and November 2024. Procedures were performed under general anesthesia using real-time ultrasound, fluoroscopy, and CT guidance. A standard freeze-thaw-freeze protocol was applied, with adjustments for larger lesions and proximity to critical structures. Post-procedure monitoring included short-term observation followed by scheduled clinical evaluations and MRI scans at 3, 6, and 12 months. Clinical response was graded on a three-point scale (no, partial, and complete response), while imaging response was based on the percentage of lesion fibrosis.

A complete clinical response was achieved in 78% of patients after a mean of 4.7 months, and a complete imaging response (> 75% fibrosis) in 78% after 16.4 months. Time to clinical response was similar between treatment-naïve (4.4 months) and previously treated patients (4.8 months). Mean time to > 75% fibrosis was 12.4 months in treatment-naïve and 17.5 months in previously treated patients. The mean number of procedures per patient was two, and cryoablation proved effective even in 83% of cases with previous treatment failure. Complications included a transient peroneal nerve injury and a wound infection, both managed successfully.

Percutaneous cryoablation demonstrates high clinical and radiological success with a favorable safety profile, establishing it as a viable and effective treatment option for ABCs, particularly in recurrent or refractory cases.