The best solution is the simplest: advances in surgical and minimally invasive management of aneurysmal and simple bone cysts.

Aneurysmal bone cysts (ABCs) and simple bone cysts (SBCs) are benign osseous lesions predominantly affecting children and adolescents, typically presenting with pain, deformity, or pathologic fracture. Despite their frequency, optimal management remains debated. This review synthesizes current evidence on therapeutic strategies, efficacy, recurrence, and safety. For ABCs, intralesional curettage remains the standard surgical approach, though recurrence rates vary and are reduced with adjuvants such as high-speed burring, cryotherapy, or cementation. En bloc resection offers the lowest recurrence; however, it is restricted by procedural morbidity and poor functional outcomes. Minimally invasive modalities, including sclerotherapy, selective arterial embolization, endoscopic curettage, and image-guided ablation, consistently achieve high rates of healing, pain relief, and functional recovery, often with fewer complications. Management of SBCs ranges from observation to intervention in symptomatic or unstable lesions. Elastic stable intramedullary nailing (ESIN) provides both decompression and structural stability, with high healing rates. Overall, advances in minimally invasive and biologic therapies are reshaping treatment paradigms, yet standardized outcome measures and head-to-head comparative trials remain needed.