Introduction <p>Aneurysmal bone cysts are locally aggressive bone lesions. The aim of this study was to evaluate safety and effectiveness of radio-opaque gelified ethanol sclerotherapy in treating primary aneurysmal bone cyst.</p> Materials and Methods <p>In this single-center, retrospective study (January 1st, 2012, to June 30th, 2024), 32 patients with primary aneurysmal bone cysts were treated with percutaneous sclerotherapy using radio-opaque gelified ethanol at various skeletal sites. Of these, 27 patients were included in the analysis, 5 patients were excluded due to follow-up of less than 12&#xa0;months. The primary outcome measure was the safety of the procedures. Secondary outcomes measures included clinical success, defined as the absence of post-sclerotherapy fractures or the need for surgical revision, and radiological success, determined by the conversion of an active or aggressive aneurysmal bone cyst to inactive, according to Campanacci's classification.</p> Results <p>No major complications related to the procedure were observed. One minor complication (3.7%) was reported: One local collection resolved with antibiotic therapy. The remaining patients showed favorable clinical and radiological outcomes. No fractures were recorded after sclerotherapy. Surgical revision for progressive recurrence was necessary in 2 cases (7.4%). Aneurysmal bone cyst becoming inactive in 21 of 27 (77.8%) patients after 12&#xa0;months, 13 of 14 (92.8%) patients after 24&#xa0;months, and 7 of 7 (100%) and 5 of 5 (100%) patients after more than 36 and 48&#xa0;months, respectively.</p> Conclusion <p>Radio-opaque gelified ethanol sclerotherapy offers a safe, effective, and minimally invasive treatment for primary aneurysmal bone cyst. It may be considered a first-line approach, similar to other sclerotherapy methods, potentially avoiding the need for invasive surgery as an initial treatment option</p> <b>Graphical Abstract</b> <p></p>