Giant sacral aneurysmal bone cyst treated with endovascular embolization

Background: Spine aneurysmal bone cysts (SABC) are osteolytic tumor-like lesions with cystic, blood-filled cavities that represent 15% of all primary spinal bone tumors. The sacrum is a rare site for SABC, and sacral lesions typically carry higher morbidity rates. Here, a 19-year-old female with a large primary multisegmental sacral SABC was successfully managed with 2-staged endovascular embolization.

Case description: A 19-year-old female presented with progressive worsening of axial lumbosacral pain, and a left L5/S1 radiculopathy. The lumbosacral computed tomography and magnetic resonance studies showed a large (10 cm [AP] × 11 cm [Tr] × 12 cm [CC]) heterogeneous, osteolytic lesion containing multiple fluid-fluid levels. The biopsy confirmed the diagnosis of a primary SABC. She was treated with a 2-staged endovascular embolization that resolved her pain. This was followed by radiographic confirmation of occlusion of the SABC.

Conclusion: A 19-year-old female presented with an atypical SABC that was successfully managed with 2-staged endovascular embolization.