Handling a Giant Cervical Aneurysmal Bone Cyst of C2 Vertebrae: Anesthetic Challenges

Introduction: Cervical Aneurysmal Bone Cyst (ABC), constituting approximately 2% of total spinal aneurysms, poses a distinct challenge for anesthesiologists. These benign yet locally aggressive, proliferative, and extensively osseous lesions are frequently associated with pathological fractures, significant blood loss, and positioning complexities, thereby presenting considerable difficulties in airway management. This report details the successful management of a colossal cervical aneurysmal bone cyst at our institution.Case Report: An 18-year-old obese male (BMI 39.5 kg/m2) exhibited a progressively enlarging posterior neck swelling, limited mobility, and persistent pain. Cervical MRI revealed a 7.3 x 4.8 cm, T2 hyperintense, multi-loculated lesion on C2 vertebra, confirmed by 3D CT scan as an ABC. Given the anticipated challenges in airway management due to a short neck with restricted movements, obesity, and the risk of aneurysmal rupture, awake fiberoptic intubation was planned but declined by the patient. We opted for endotracheal intubation using video laryngoscopy during manual inline stabilization (MILS) of cervical vertebrae. General anesthesia allowed safe bony cyst debulking in the prone position, managing intraoperative hypotension with fluid resuscitation, blood products, and vasopressors. The intraoperative course remained uneventful, and post-surgery, tracheal extubation was successfully achieved.Discussion and Conclusion: Cervical ABCs, as rare spinal lesions, necessitate meticulous attention to airway security, concurrently addressing complications related to prone positioning, lesion rupture, acute blood loss, and cervical vertebrae fractures. A thorough pre-anesthetic assessment, coupled with a well-formulated anesthesia plan, vigilant hemodynamic monitoring, and comprehensive follow-up, contributes to optimal outcomes, particularly in navigating the intricacies of airway management.