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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Multidisciplinary management of a giant cervical aneurysmal bone cyst: A two-year follow-up case report featuring
Sadegh Bagherzadeh1, Faramarz Roohollahi2, Mohsen Rostami3
1Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Introduction And Importance:
Aneurysmal bone cysts (ABCs) in the cervical spine are rare and challenging due to their proximity to vital neurovascular structures and the risk of spinal instability. Optimal management aims to achieve safe resection and durable stability while minimizing complications.
Case Presentation:
A 37-year-old woman presented with four years of progressive neck pain and intermittent left-sided radiculopathy. Imaging identified a large cystic lesion spanning C3-C5, consistent with an ABC. The neurological examination revealed midline tenderness and radicular symptoms, but preserved strength and reflexes. She underwent preoperative embolization of the left vertebral artery, posterior cervical stabilization, and anterior corpectomy with cage reconstruction and cement-augmented instrumentation. Postoperatively, she recovered without neurological deficit, resumed activities early, and a two-year follow-up showed solid fusion, maintained alignment, and no recurrence.
Clinical Discussion:
This case illustrates the complexities of cervical ABC management, where surgical risks include hemorrhage, neurovascular injury, and mechanical instability. Preoperative embolization reduced intraoperative bleeding, while a two-stage approach with circumferential reconstruction and cement augmentation ensured stability and safety. Multidisciplinary planning was crucial for achieving these outcomes.
Conclusion:
A carefully staged, multidisciplinary approach-including preoperative embolization, deliberate surgical sequencing, and robust reconstruction-enables safe resection and lasting stability in challenging cervical spine ABCs, resulting in excellent long-term clinical and radiological results.
