Cryosurgery for Bone Tumors

  • H. W. Bart Schreuder


In 1968 Ralph C. Marcove introduced cryosurgery into orthopedic oncology for the treatment of primary and metastatic bone tumors by repetitive freezing. He was awarded the first prize in scientific research at the 162nd annual convention of the Medical Society of the State of New York (1). Since then more orthopedic surgeons dealing with skeletal tumors have adopted the technique, and the clinical results and experimental data of cryosurgery with specific reference to the skeletal system have been published regularly.


Bone Tumor Fibrous Dysplasia Bone Cyst Giant Cell Tumor Aneurysmal Bone Cyst 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Marcove RC, Miller TR, Cahan WC. Treatment of primary and metastatic bone tumors by repetitive freezing. Bull N Y Acad Med 1968; 44: 532–544.PubMedGoogle Scholar
  2. 2.
    Enneking WF. A staging system of staging Musculoskeletal Neoplasms. Clin Orthop 1986; 204: 9–24.PubMedGoogle Scholar
  3. 3.
    Marcove RC, Zahr KA, Huvos AG, Ogihara W. Cryosurgery in osteogenic sarcoma: a report of three cases. Compr Ther 1984; 10: 52–60.PubMedGoogle Scholar
  4. 4.
    Marcove RC, Miller TR. Treatment of primary and metastatic bone tumors by cryosurgery. JAMA 1969; 207: 1890–1894.PubMedCrossRefGoogle Scholar
  5. 5.
    Schiller CH, Ritschl P, Windhager R, Kropej D, Kotz R. Frequency of recurrence in phenolized and nonphenolized bone cavities following intralesional excisions of nonmalignant bone tumors. Z Orthop 1989; 127: 398–401.PubMedCrossRefGoogle Scholar
  6. 6.
    Capanna R, Sudanese A, Baldini N, Campanacci M. Phenol as an adjuvant in the control of local recurrence of benign neoplasms of bone treated by curettage. Ital J Orthop Traumatol 1985; 11: 381–388.PubMedGoogle Scholar
  7. 7.
    Rock MG. Treatment of bone cysts and giant cell tumors. Curr Opin Orthopaed 1990; 1: 423–434.Google Scholar
  8. 8.
    Bradley PF. Cryosurgery of the maxillofacial region, Vol 1. Boca Raton, Florida, CRC Press, 1986 chapter 5.Google Scholar
  9. 9.
    Gill W, Frazer J, Carter D. Repeated freeze-thaw cycles in cryosurgery. Nature 1968; 219: 410–413.PubMedCrossRefGoogle Scholar
  10. 10.
    Gage A. Experimental cryogenic injury of the palate: observations pertinent to cryosurgical destruction of tumors. Cryobiology 1978; 15: 415–425.PubMedCrossRefGoogle Scholar
  11. 11.
    Neel HB, Ketcham AS, Hammond WG. Requisites for successful cryogenic surgery of cancer. Arch Surg 1971; 102: 45.PubMedCrossRefGoogle Scholar
  12. 12.
    Berth-Jones J, Bourke J, Eglitis H, Harper C, Kirk P, Pavord S, Rajapakse R, Weston P, Wiggins T, Hutchinson PE. Value of a second freeze-thaw cycle in cryotherapy of common warts. Br J Dermatol 1994; 131: 883–886.PubMedCrossRefGoogle Scholar
  13. 13.
    Gage AA. What temperature is lethal for cells? J Dermatol Surg Oncol 1979; 5: 459–460.PubMedGoogle Scholar
  14. 14.
    Gage AA, Guest K, Montes M, Caruana JA, Whalen Jr DA. Effect of varying freezing and thawing rates in experimental cryosurgery. Cryobiology 1985; 22: 175–182.PubMedCrossRefGoogle Scholar
  15. 15.
    Bradley PF. Thermography. In: Bradley P (ed): Cryosurgery of the maxillofacial region, Vol 1. Boca Raton, Florida, CRC Press, 1986:130–132.Google Scholar
  16. 16.
    Ravikumar T, Kane R, Cady B et al. Hepatic cryosurgery with intraoperative ultrasound monitoring for metastatic colon carcinoma. Arch Surg 1987; 122: 403–409.PubMedCrossRefGoogle Scholar
  17. 17.
    Laugier P, Berger G. Assessment of echography as a monitoring technique for cryosurgery. Ultrason Imaging 1993; 15: 14–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Le Pivert P. The measurement of low frequency electrical impedance as a guide to effective cryosurgery. J Dermatol Surg Oncol 1977; 3: 395–397.PubMedGoogle Scholar
  19. 19.
    Gage AA, Augustynowicz S, Montes M. Tissue impedance and temperature measurements in relation to necrosis in experimental cryosurgery. Cryobiology 1985; 22: 282–288.PubMedCrossRefGoogle Scholar
  20. 20.
    Gage A. Correlation of electrical impedance and temperature in tissue during freezing. Cryobiology 1979; 16: 56–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Moser R, Abbott I, Stephens C. Computerized tomographic imaging of cryosurgical iceball formation in brain. Cryobiology 1987; 24: 368–379.PubMedCrossRefGoogle Scholar
  22. 22.
    Pease GR, Rubinsky B, Wong STS. An integrated probe for magnetic resonance imaging monitored skin cryosurgery. J Biomech Eng 1995; 117: 59–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Hong JS, Wong S, Pease G, Rubinsky B. MR imaging assisted temperature calculations during cryosurgery. Magn Reson Imaging 1994; 12: 1021–1031.PubMedCrossRefGoogle Scholar
  24. 24.
    Matsumoto R, Selig AM, Colucci VM, Jolsz FA. MR monitoring during cryotherapy in the liver: predictability of histologic outcome. J Magn Reson Imaging 1993; 3: 770–776.PubMedCrossRefGoogle Scholar
  25. 25.
    Schreuder HW, van Egmond J, van Beem HB, Veth RP. Monitoring during cryosurgery for bone tumors. J Surg Oncol 1997; 65: 40–45.PubMedCrossRefGoogle Scholar
  26. 26.
    Bischof J, Christov K, Rubinsky B. A morphological study of cooling rate response in normal and neoplastic human liver tissue: cryosurgical implications. Cryobiology 1993; 30: 482–492.PubMedCrossRefGoogle Scholar
  27. 27.
    Lowdon JD, Tidmore TL Jr. Fatal air embolism after gastrointestinal endoscopy. Anesthesiology 1988; 69: 622–623.PubMedCrossRefGoogle Scholar
  28. 28.
    Jacoby J, Jones JR, Ziegler J. Pneumoencephalography and air embolism; Simulated anaesthetic death. Anesthesiology 1959; 20: 336.PubMedCrossRefGoogle Scholar
  29. 29.
    Saha AK. Air embolism during anaesthesia for arthrography in a child. Anaesthesia 1976; 31: 1231–1233.PubMedCrossRefGoogle Scholar
  30. 30.
    Schreuder HW, van Beem HB, Veth RP. Venous gas embolism during cryosurgery for bone tumors. J Surg Oncol 1995; 60: 196–200.PubMedCrossRefGoogle Scholar
  31. 31.
    Scaglietti O, Marchetti PGM, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (Depo-Medrol) and a discussion of results achieved in other bone lesions. Clin Orthop 1982; 165: 33–42.PubMedGoogle Scholar
  32. 32.
    Scaglietti O, Marchetti PGM, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. J Bone Joint Surg 1979; 61: 200–204.Google Scholar
  33. 33.
    Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop 1986; 204: 25–36.PubMedGoogle Scholar
  34. 34.
    Bovill DF, Skinner HB. Unicameral bone cysts. A comparison of treatment options. Orthop Rev 1989; 18: 420–427.PubMedGoogle Scholar
  35. 35.
    Pentimalli G, Tudisco C, Scola E, Farcetti P, Ippolito E. Unicameral bone cysts-comparison between surgical and steroid injection treatment. Arch Orthop Trauma Surg 1987; 106: 251–256.PubMedCrossRefGoogle Scholar
  36. 36.
    Inoue O, Ibaraki K, Shimabukuro H, Shingaki Y. Packing with highporosity hydroxyapatite cubes alone for the treatment of simple bone cysts. Clin Orthop 1993; 293: 287–292.PubMedGoogle Scholar
  37. 37.
    Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop 1984; 4: 1–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cyst: treatment with freeze-dried crushed cortical-bone allograft. A review of one hundred and forty-four cases. J Bone Joint Surg Am 1976; 58: 636–641.PubMedGoogle Scholar
  39. 39.
    Spence KF, Sell KW, Brown RH. Solitary bone cyst: treatment with freeze-dried cancellous bone allograft. A study of one hundred seventy-seven cases. J Bone Joint Surg 1969; 51: 87–96.PubMedGoogle Scholar
  40. 40.
    Neer CS II, Marcove RC, Terz and Carbonara PN. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg 1966; 48: 731–745.PubMedGoogle Scholar
  41. 41.
    Mylle J, Burssens A, Fabry G. Simple bone cysts. A review of 59 cases with special reference to their treatment. Arch Orthop Trauma Surg 1992; 111: 297–300.PubMedCrossRefGoogle Scholar
  42. 42.
    Morton KS. Unicameral bone cyst. Can J Surg 1982; 25: 330–332.PubMedGoogle Scholar
  43. 43.
    Schreuder HW, Conrad EU, Bruckner JD, Howlett AT, Sorensen LS. Treatment of simple bone cysts in children with curettage and cryosurgery. J Pediatr Orthop 1997; 17: 814–820.PubMedGoogle Scholar
  44. 44.
    Schreuder HW, Keijser LC, Veth RP. Favourable results of cryosurgery in 120 patients with benign or low-grade malignant bone tumors. Ned Tijdschr Geneeskd 1999; 143(45): 2275–2281.PubMedGoogle Scholar
  45. 45.
    Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. Am J Roentgenol 1995; 164: 573–580.Google Scholar
  46. 46.
    Clough JR, Price CHG. Aneurysmal bone cysts: Pathogenesis and long term results of treatment. Clin Orthop 1973; 97: 52–63.PubMedCrossRefGoogle Scholar
  47. 47.
    Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN. Aneurysmal bone cysts in young children. J Pediatr Orthop 1994; 14: 86–91.PubMedCrossRefGoogle Scholar
  48. 48.
    Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clin Orthop 1995; 311: 157–163.PubMedGoogle Scholar
  49. 49.
    Ruiter DJ, van Rijssel ThG, van der Velde EA. Aneurysmal bone cysts. A clinicopathological study of 105 cases. Cancer 1977; 39: 2231–2239.PubMedCrossRefGoogle Scholar
  50. 50.
    Cole WG. Treatment of aneurysmal bone cysts in childhood. J Pediatr Orthop 1986; 6: 326–329.PubMedCrossRefGoogle Scholar
  51. 51.
    Szendröi M, Cser I, Konya A, Renyi-Vamos A. Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases. Arch Orthop Trauma Surg 1992; 111: 318–322.PubMedCrossRefGoogle Scholar
  52. 52.
    Schreuder HWB, Veth RPH, Pruszczynski M, Lemmens JAM, Schraffordt Koops H, Molenaar WM. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg (Br) 1997; 79: 20–25.CrossRefGoogle Scholar
  53. 53.
    Farsetti P, Tudisco C, Rosa M, Pentimalli G, Ippolito E. Aneurysmal bone cyst. Long-term follow-up of 20 cases. Arch Orthop Trauma Surg 1990; 109: 221–223.PubMedCrossRefGoogle Scholar
  54. 54.
    Kreicbergs A, Lonnqvist PA, Nilsson B. Curettage of benign lesions of bone. Factors related to recurrence. Int Orthop 1985; 8: 287–294.PubMedCrossRefGoogle Scholar
  55. 55.
    van Loon CJ, Veth RP, Pruszczynski M, van Horn JR, Lemmens JA. Aneurysmal bone cyst. Long-term results and functional evaluation of 16 primary cases in 13 patients. Acta Orthop Belgica 1995; 61:199–204.Google Scholar
  56. 56.
    Slowick FA Jr, Campbell CJ, Kettelkamp DB. Aneurysmal bone cyst. An analysis of thirteen cases. J Bone Joint Surg Am 1968; 50: 1142–1151.PubMedGoogle Scholar
  57. 57.
    Nobler MP, Higinbotham NL, Phillips RF. The cure of aneurysmal bone cyst. Irradiation superior to surgery in an analysis of 33 cases. Radiology 1968; 90: 1185–1192.PubMedGoogle Scholar
  58. 58.
    Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 1992; 69: 2921–2931.CrossRefGoogle Scholar
  59. 59.
    Koskinen EV, Visuri TI, Holmstrom T, Roukkula MA. Aneurysmal bone cyst: evaluation of resection and of curettage in 20 cases. Clin Orthop 1976; 118: 136–146.PubMedGoogle Scholar
  60. 60.
    Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. Clin Orthop 1999; 2: 176–188.Google Scholar
  61. 61.
    Marcove RC, Lyden JP, Huvos AG, Bullough PG. Giant cell tumors treated by cryosurgery. A report of twenty-five cases. J Bone Joint Surg (Am) 1973; 55: 1633–1644.Google Scholar
  62. 62.
    Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R. Cryosurgery in the treatment of giant cell tumors of bone. A report of 52 consecutive cases. Clin Orthop 1978; 134: 275–289.PubMedGoogle Scholar
  63. 63.
    Jacobs PA, Clemency Jr RE. The closed cryosurgical treatment of giant cell rumor. Clin Orthop 1985; 192: 149–158.PubMedGoogle Scholar
  64. 64.
    Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop 1991; 262: 42–57.PubMedGoogle Scholar
  65. 65.
    Aboulafia AJ, Rosenbaum DH, Sicard-Rosenbaum L, Jelinek JS, Malawer MM. Treatment of large subchondral tumors of the knee with cryosurgery and composite reconstruction. Clin Orthop 1994; 307: 189–199.PubMedGoogle Scholar
  66. 66.
    Makley JT, Carter JR. Eosinophilic granuloma of bone. Clin Orthop 1986; 204: 37–44.PubMedGoogle Scholar
  67. 67.
    Capanna R, Springfield DS, Ruggieri P, Biagini R, Picci P, Bacci G, Giunti A, Lorenzi EG, Campanacci M. Direct cortisone injection in eosinophilic granuloma of bone: a preliminary report on 11 patients. J Pediatr Orthop 1985; 5: 339–342.PubMedCrossRefGoogle Scholar
  68. 68.
    Greis PE, Hankin FM. Eosinophilic granuloma. The management of solitary lesions of bone. Clin Orthop 1990; 257: 204–211.PubMedGoogle Scholar
  69. 69.
    Sartoris DJ, Parker BR. Histiocytosis X: rate and pattern of resolution of osseous lesions. Radiology 1984; 152: 679–684.PubMedGoogle Scholar
  70. 70.
    Cohen M, Zornoza J, Cangir A, Murray JA, Wallace S. Direct injection of methylprednisolone sodium succinate in the treatment of solitary eosinophilic granuloma of bone: a report of 9 cases. Radiology 1980; 136: 289–293.PubMedGoogle Scholar
  71. 71.
    Nauert C, Zomoza J, Ayala A, Harle TS. Eosinophilic granuloma of bone: diagnosis and management. Skeletal Radiol 1983; 10: 227–235.PubMedCrossRefGoogle Scholar
  72. 72.
    Egeler RM, Thompson Jr, RC Voute PA, Nesbit ME Jr. Intralesional infiltration of corticosteroids in localized Langerhans’ cell histiocytosis. J Pediatr Orthop 1992; 12: 811–814.PubMedCrossRefGoogle Scholar
  73. 73.
    Schreuder HW, Pruszczynski M, Lemmens JA, Veth RP. Eosinophilic granuloma of bone: results of treatment with curettage, cryosurgery and bone grafting. J Pediatr Orthop B 1998; 7: 253–256.PubMedCrossRefGoogle Scholar
  74. 74.
    Meachim G. Histological grading of chondrosarcomata. J Bone Joint Surg (Br) 1979; 61: 4–5.Google Scholar
  75. 75.
    Mirra JM, Gold R, Downs J, Eckardt JJ. A new histologic approach to the differentiation of enchondroma and chondrosarcoma of the bones. A clinicopathologic analysis of 51 cases. Clin Orthop 1985; 201: 214–237.PubMedGoogle Scholar
  76. 76.
    Giudici MA, Moser Jr, RP Kransdorf MJ. Cartilaginous bone tumors. Radiol Clin North Am 1993; 31: 237–259.PubMedGoogle Scholar
  77. 77.
    Bresser E, Roessner A, Brugg E, Erlemann R, Timm C, Grundman E. Bone tumors of the hand. A review of 300 cases documented in the Westphalian Bone Tumor Register. Arch Orthop Trauma Surg 1987; 106: 241–247.CrossRefGoogle Scholar
  78. 78.
    Marcove RC. Chondrosarcoma: diagnosis and treatment. Orthop Clin North America 1977; 8: 811–820.Google Scholar
  79. 79.
    Healey JH, Lane JM. Chondrosarcoma. Clin Orthop 1986; 204:119–129.PubMedGoogle Scholar
  80. 80.
    Schwartz HS, Zimmerman HB, Simon MA, Wroble RR, Millar EA, Bonfiglio M. The malignant potential of enchondromatosis. J Bone Joint Surg (Am) 1987; 69: 269–274.Google Scholar
  81. 81.
    Bauer HCF, Brosjo O, Kreicbergs A, Lindholm J. Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2-25 years. Acta Orthop Scand 1995; 66:283–288.PubMedCrossRefGoogle Scholar
  82. 82.
    Quint U, Pingsmann A. Surgical treatment of enchondroma in long tubular bones. Preservation of function versus extensive excision in the humerus. Arch Orthop Trauma Surg 1995; 114: 352–356.PubMedCrossRefGoogle Scholar
  83. 83.
    Eriksson AI, Schiller A, Mankin HJ. The management of chondrosarcoma of bone. Clin Orthop 1980; 153: 44–66.PubMedGoogle Scholar
  84. 84.
    Schreuder HW, Pruszczynski M, Veth RP, Lemmmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumors with curettage and cryosurgery. Eur J Surg Oncol 1998; 24: 120–126.PubMedCrossRefGoogle Scholar
  85. 85.
    Enneking WF. Fibrous dysplasia (84 cases). In: Enneking WF: Musculoskeletal tumor surgery. New York: Churchill Livingstone 1983: 855–867.Google Scholar
  86. 86.
    Keijser LCM, van Tienen TG, Schreuder HW, Lemmens JA, Pruszczynski M, Veth RP. Fibrous dysplasia of bone; management and outcome of 20 cases. Submitted.Google Scholar
  87. 87.
    Marcove RC, Stovell PB, Huvos AG, Bullough PG. The use of cryosurgery in the treatment of low and medium grade chondrosarcoma. A preliminary report. Clin Orthop 1977; 122: 147–156.PubMedGoogle Scholar
  88. 88.
    Dwyer DM, Thorne AC, Healey JH, Bedford RF. Liquid nitrogen instillation can cause venous gas embolism. Anesthesiology 1990; 73: 179–181.PubMedCrossRefGoogle Scholar
  89. 89.
    Marcove RC. A 17-year review of cryosurgery in the treatment of bone tumors. Clin Orthop 1982; 163: 231–234.PubMedGoogle Scholar
  90. 90.
    de Vries J. Bonemarrow embolism and cryosurgery. Thesis, Groningen, 1983.Google Scholar
  91. 91.
    Pell AC, Christie J, Keating JF, Sutherland GR. The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing: a study of 24 patients with femoral and tibial fractures. J Bone Joint Surg (Br) 1993; 75-B: 921–925.Google Scholar
  92. 92.
    Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg (Br) 1994; 76-B: 409–412.Google Scholar
  93. 93.
    Russe W, Kerschbaumer F, Bauer R. Kryochirurgie in der Orthopädie. Orthopäde 1984; 13: 142–150.PubMedGoogle Scholar
  94. 94.
    Fisher AD, Williams DF, Bradley PF. The effect of cryosurgery on the strength of bone. Br J Oral Surg 1978; 15: 215–222.PubMedCrossRefGoogle Scholar
  95. 95.
    Gage AA, Emmings FG. Bone freezing in cryotherapy. J Barnabus Med Center 1967; 4: 314–319.Google Scholar
  96. 96.
    Schargus G, Winckler J, Schröder F, Schäfer B. Cryosurgical devitalization of bone and its regeneration. An experimental study with animals. J Maxillofac Surg 1975; 3: 128–131.PubMedCrossRefGoogle Scholar
  97. 97.
    Malawer MM, Marks MR, McChesney D, Piasio M, Gunther SF, Schmookler BM. The effect of cryosurgery and polymethylmethacrylate in dogs with experimental bone defects comparable to tumor defects. Clin Orthop 1988; 226: 299–310.PubMedGoogle Scholar
  98. 98.
    Alkalay D, Kollender Y, Mozes M, Meller I. Giant cell tumors with intraarticular fracture. Two-stage local excision, cryosurgery and cementation in 5 patients with distal femoral tumor followed for 2–4 years. Acta Orthop Scand 1996; 67(3): 291–294.PubMedCrossRefGoogle Scholar
  99. 99.
    Marcove RC, Sheth DS, Brien EW, Huvos AG, Healey JH. Conservative surgery for giant cell tumor of the sacrum. Cancer 1994; 74: 1253–1260.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2001

Authors and Affiliations

  • H. W. Bart Schreuder

There are no affiliations available

Personalised recommendations