Excision Of Nidus Research Articles

Is Intraoperative CT Navigation feasible for excision of osteoid osteoma in the appendicular skeleton? – Retrospective analysis of 58 cases

BackgroundThe use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methodsBetween May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. ResultsOf the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6–100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. ConclusionUsing intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study designRetrospective Case Series. Level of evidenceLevel IV.

Non-Angry Superficial Draining Veins: A New Technique in Identifying the Extent of Nidus Excision during Cerebral Arteriovenous Malformation Surgery

As essential techniques, intraoperative indocyanine green video angiography (ICG-VA) and FLOW 800 have been widely used in microsurgery for arteriovenous malformations (AVMs). In the present report, we introduced a supplementary technical trick for judging the degree of lesion resection when there were superficial drainage veins. FLOW 800 analysis is used to verify our conjecture. A retrospective analysis of a 33 case cohort treated surgically from June 2020 to September 2022 was conducted and their lesions were removed by superficial drainage veins as a supplementary technical trick and analyzed with FLOW800. In our 33 AVMs, the feeding artery was visualized earlier than the draining vein. Intraoperatively, the T1/2 peak and slope of the draining vein were significantly higher than that of the lesion. However, the maximum fluorescence intensity (MFI) of the draining vein decreased as the procedure progressed (p < 0.001). After reducing the blood flow to the nidus by progressive dissection of the feeding artery, the arteriovenous transit time (AVTT) decreased from 0.64 ± 0.47 s, was prolonged to 2.38 ± 0.52 (p < 0.001), and the MFI and slope of the nidus decreased from the pre-resection 435.42 ± 43.90 AI and 139.77 ± 27.55 AI/s, and decreased to 386.70 ± 48.17 AI and 116.12 ± 17.46 AI/s (p < 0.001). After resection of the nidus, the T1/2 peak of the draining vein increased from 21.42 ± 4.70 s, prolonged to after dissection of the blood feeding artery, 23.07 ± 5.29 s (p = 0.424), and after resection of the lesion, 25.13 ± 5.46 s (p = 0.016), with a slope from 135.79 ± 28.17 AI/s increased to 210.86 ± 59.67 AI/s (p < 0.001). ICG-VA integrated with FLOW 800 is an available method for determining the velocity of superficial drainage veins. Whether the color of the superficial drainage veins on the cortical surface returns to normal can determine whether the lesion is completely resected and can reduce the possibility of residual postoperative lesions.

Osteoid Osteomas of Spine: From Open to Minimally Invasive Excision of the Nidus – A Case series

Osteoid osteomas of spine are not uncommon and majority of which occurs in posterior elements of lumbar spine. Management of such lesions in spine ranges from open en bloc excision to percutaneous radiofrequency ablation. In this series, we have managed three cases of osteoid osteomas of spine, each managed differently from conventional open technique to minimally invasive method. All three cases underwent appropriate radiological investigations and followed by surgical excision of the lesion and histopathological analysis post-operatively. First case was managed with open excision of the lesion with conventional unilateral pedicle screw stabilisation. Second case, who underwent open excision of the lesion developed recurrence which was managed by re-excision without any further complications. Last case underwent microendoscopic quadrant tubular excision of the tumour with unilateral MISS with pedicle screws. The technique of Microendoscopic quadrant tubular excision of posterior element benign tumour had advantages of small skin incision, less bleeding, clear macroscopic visualisation of the small tumour (enables complete excision of the nidus thus decreasing the recurrence), early mobilisation and shorter hospitalization with effective and complete excision of the tumour better than open method. Further, histological evidence of tumour will be available. The complete excision of nidus using microendoscopic tubular retractors with unilateral fixation in young age gives encouraging results. This case series is followed by review of literature highlighting the role of COX-2 inhibitors in osteoid osteoma, cause for scoliosis and neurological deficit in osteoid osteoma and management of osteoid osteomas of spine. Keywords: Tumor, Osteoid osteoma, Minimally invasive, Dorsolumbar spine, Excision biopsy

Onyx Embolization Before the Surgical Treatment of Grade III Spetzler-Martin Brain Arteriovenous Malformations: Single-Center Experience and Technical Nuances

Grade III Spetzler-Martin brain arteriovenous malformations (AVMs) are a specific set of AVMs with high variability in terms of site, size, angioarchitecture, flow dynamics, and involvement of eloquent areas. Surgery preceded by preoperative embolization has been reported as a useful treatment option for these lesions. The aim of this study is to report outcomes and personal experience of combined preoperative Onyx embolization and surgical resection on a consecutive series of grade III brain AVMs. Between 2005 and 2017, 27 grade III AVMs were treated by means of a staged Onyx embolization and subsequent surgical treatment. Site and size of the AVMs, embolization, and surgical specifics as well as complications and outcomes were retrospectively reviewed. All AVMs were supratentorial, 13 of which were hemorrhagic. Mean nidal volume was 19.5 mL. Average embolization sessions were 1.6. Mean embolization-related obliteration rate and morbidity were 28.8% and 3.7%, respectively. Surgery was performed within 3.7 days on average. In our experience, Onyx embolization made the nidus excision easier, facilitated the hemostasis, and contributed to the early identification of the lesion in cases of small or racemose nidus. The surgical obliteration rate was 92.6%. A good overall outcome (modified Rankin Scale score 0-2) was achieved in 70.4% of patients. In our experience, preoperative Onyx embolization helped the surgical management of grade III Spetzler-Martin brain AVMs. Careful evaluation of the angioarchitecture, a tailored strategy in the embolization process, and full cooperation within the neurosurgical-neuroendovascular team are mandatory.

Compendium of scalp arteriovenous malformation (AVM) cases—a retrospective study and review

Arteriovenous malformations (AVMs) are abnormal connections between arterial feeding vessels and draining veins, devoid of a normal capillary bed. Treatment options include complete surgical excision or eradication. Following surgical excision, the defect can be closed primarily or covered with the preplanned local flap or skin graft. We aimed to assess various cases of AVMs and review the current literature to determine a treatment rationale and improve surgical outcomes. A retrospective study including data of 21 patients with extra cranial scalp AVMs was carried out at our institute between 2010 and 2016. Fourteen patients underwent digital subtraction angiography; remaining patients were evaluated by MR/CT angiography. Eighteen patients underwent direct excision. Three patients with large AVMs (> 10 cm) underwent preoperative embolization followed by surgical excision. Of the 21 patients with extra cranial scalp AVMs, there were 11 males and 10 females with mean age of 24 years ranging from 3 to 41 years. The mean duration of symptom was 6.7 years. Superficial temporal artery (62%) was the most commonly involved feeder vessel. Eighteen patients underwent direct excision while three underwent embolization followed by excision. Two patients had recurrence of symptoms. There was partial flap necrosis in three patients which were managed with dressings and skin graft. Surgical excision of AVMs, which includes ligation of all arterial feeders near the nidus and excision of nidus, is a safe option with lesser complications and gives good results. Preoperative embolization reduces vascularity and helps in easy identification of AVMs during surgery thus achieving complete excision and improving the prognosis of treatment especially in the large AVM. Level of Evidence: Level IV, therapeutic study.

An Alternative Surgical Method for Treatment of Osteoid Osteoma.

BackgroundAn osteoid osteoma is a benign bone tumor that tends to be <1 cm in size. The tumor is characterized by night-time pain that may be relieved by aspirin or other non-steroidal anti-inflammatory drugs. Osteoid osteoma can be treated with various conservative and surgical methods, but these have some risks and difficulties. The purpose of the present study was to present an alternative treatment method for osteoid osteoma and the results we obtained.Material/MethodsIn the period from 2010 to 2014, 10 patients with osteoid osteoma underwent nidus excision by using a safe alternative method in an operating room (OR) with no computed tomography (CT). The localization of the tumor was determined by use of a CT-guided Kirschner wire in the radiology unit, then, in the OR the surgical intervention was performed without removing the Kirschner wire.ResultsFollowing the alternative intervention, all the patients were completely relieved of pain. In the follow-up, no recurrence or complication occurred.ConclusionsThe presented alternative method for treating osteoid osteoma is an efficient and practical procedure for surgeons working in clinics that lack specialized equipment.

Gamma probe guided surgery for osteoid osteoma: Is there any additive value of quantitative bone scintigraphy?

The aim of this study is to evaluate the efficiency of gamma probe guided osteoid osteoma surgery and the applicability of quantitative analyses obtained from preoperative bone scan images. This study involved 12 osteoid osteoma patients who were treated with gamma probe guided surgery after preoperative bone scan. The calculated contrast ratios between nidus and adjacent healthy bone from preoperative bone scan and the calculated percentages of count reduction after resection of nidus during intraoperative gamma probe application were compared. Patients were followed up for any recurrence or complications. The mean contrast ratio between nidus and adjacent healthy bone calculated from preoperative bone scan was 43.6% (range 33-53%). Following the nidus excision, an average of 55.8% (range 28-73%) count reduction was estimated with gamma probe in the tumor area. There was no correlation between preoperative scintigraphic contrast ratio and intraoperative gamma probe count reduction ratio (r = 0.46, p = 0.13). Complete cure was achieved in 11 (92%) patients with single operation, during the postoperative follow up period. None of the patients had any major or minor complications during or after the surgery. Due to high clinical success and low complication rate in osteoid osteoma surgery, gamma probe application is an effective and safe method that should be used more extensively in daily practice.

Gamma probe guided surgery for osteoid osteoma: Is there any additive value of quantitative bone scintigraphy?

ObjectiveThe aim of this study is to evaluate the efficiency of gamma probe guided osteoid osteoma surgery and the applicability of quantitative analyses obtained from preoperative bone scan images. Material and methodsThis study involved 12 osteoid osteoma patients who were treated with gamma probe guided surgery after preoperative bone scan. The calculated contrast ratios between nidus and adjacent healthy bone from preoperative bone scan and the calculated percentages of count reduction after resection of nidus during intraoperative gamma probe application were compared. Patients were followed up for any recurrence or complications. ResultsThe mean contrast ratio between nidus and adjacent healthy bone calculated from preoperative bone scan was 43.6% (range 33-53%). Following the nidus excision, an average of 55.8% (range 28-73%) count reduction was estimated with gamma probe in the tumor area. There was no correlation between preoperative scintigraphic contrast ratio and intraoperative gamma probe count reduction ratio (r = 0.46, p = 0.13). Complete cure was achieved in 11 (92%) patients with single operation, during the postoperative follow up period. None of the patients had any major or minor complications during or after the surgery. ConclusionsDue to high clinical success and low complication rate in osteoid osteoma surgery, gamma probe application is an effective and safe method that should be used more extensively in daily practice.

Osteoid Osteoma of Proximal Phalanx of the Index Finger of the Right Hand

Osteoid osteoma is a benign bone forming tumor of the growing skeleton that is most often seen in young men. It represents by pain and radiologic appearance of anidus surrounded by osteosclerosisthat occurs mostly in long bones of the lower extremity. Occurrence of this tumor in the hand is an uncommon condition. We present a 23-year-old man with an osteoid osteoma in the proximal phalanx of the right index finger. The radiological examination showed a lytic lesion with irregular border with a central sclerotic nidus and also sclerotic changes around the lytic lesion and bone expansion in the proximal phalanx of the right index finger. He was suffering from a history of pain and swelling of his finger since 8 months. The pain disappeared after surgical excision of nidus. The patient was pain-free and there was no evidence of recurrence at 15 months follow up.

Osteoid Osteoma of the Spine: A Novel Technique Using Combined Computer-Assisted and Gamma Probe-Guided High-Speed Intralesional Drill Excision

A report of five cases of thoracolumbar osteoid osteoma treated with combined computer-assisted and gamma probe-guided high-speed drill excision. To document the surgical technique consisting of a combination of both computer-assisted and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine. Curative treatment of spinal osteoid osteoma is performed by surgical intralesional excision of the nidus, but intraoperative localization of the nidus is often difficult. Although intraoperative gamma-probe guidance facilitates accurate localization of the nidus, wide surgical resection of the bony structure is still mandatory to ensure removal of the nidus. Computer-assisted surgery has been proven to facilitate surgical intervention in spinal surgery. However, there is no clinical report regarding the application and usefulness of computer-assisted intralesional excision of the osteoid nidus. Excision of the nidus with a computer-assisted high-speed drill and intraoperative gamma probe control may result in complete intralesional excision without sacrificing more bone than necessary. One day before surgery, patients were injected with radioactive mTc-oxidronate. With a computed tomography-based electro-optical navigation system, real-time virtual images of the osteoid osteoma were generated by matching the intraoperative surface with preoperative computed tomography images. The osteoid osteoma was excised with the use of an image-guided high-speed drill, and complete excision was controlled with a gamma detection probe. Excision of the nidus was confirmed by relief of symptoms, postexcision computed tomography scans, and histologic evaluation on clinical and radiographic follow-up observation. All five patients reported immediate complete relief of characteristic pain and no evidence of recurrence after 6 to 33 months of follow-up observation. There were no complications. The combination of both computer-assisted surgery and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine helps to localize and excise the nidus of the osteoid osteoma with minimal bone resection of the posterior spinal structures.

確実な脳動静脈奇形全摘のための手術戦略

There is high risk of intraoperative hemorrhage in AVM surgery due to abnormal vessels and changing hemodynamic pattern of brain. Inadequate coagulation of vessels, arterialization of veins and loss of tissue planes are major pitfalls. Preoperative embolization and temporary clipping of feeding arteries contribute to safe surgical techniques. There were 281 patients who underwent treatment for AVM in our institution: 242 were operated (99 of them with intracerebral hemorrhage) and 39 cases were treated with embolization and/or gamma knife. Radiological evaluation was carried out by CT, dynamic and 3D-CT, MRI, fMRI, MRA, and surface anatomy scanning. Strategic image analysis and preoperative embolization were employed where feeders were behind the nidus or vein and where another craniotomy was found necessary to secure feeding arteries. Endovascular nidus obliteration is successful only in 10% of patients. Surgical results showed risk of intraoperative bleeding in Grade 4 and 5 cases (1.5%). Recovery showed GR (205), MD (13), SD (7), PVS (2), and death (15) on 242 cases, based on Glasgow Outcome Score. Preoperative staged nidus embolization helps prevent bleeding in large AVM; small superficial lesions have the best results with surgery. Temporary clips for feeders, good plane between nidus and brain, definition of eloquent cortex, adequate coagulation of draining veins and total nidus excision are important steps in surgical strategy.

Surgical Management of High-grade Intracranial Dural Arteriovenous Fistulas: Leptomeningeal Venous Disruption without Nidus Excision

Surgical Management of High-grade Intracranial Dural Arteriovenous Fistulas: Leptomeningeal Venous Disruption without Nidus Excision

Surgical Management of High-grade Intracranial Dural Arteriovenous Fistulas: Leptomeningeal Venous Disruption without Nidus Excision

Surgical Management of High-grade Intracranial Dural Arteriovenous Fistulas: Leptomeningeal Venous Disruption without Nidus Excision

Preoperative CT localization and marking of osteoid osteoma: description of a new technique.

We describe a new technique for the preoperative localization of an osteoid osteoma nidus. Four lesions (mean patient age 26 years) were localized with CT. A needle was advanced into the cortex, methylene blue was injected, and a self-retaining localization wire was then left in place. A final CT image confirmed localization. The site of marking was identified intraoperatively by following the guide wire to the cortical mark, permitting nidus excision with minimal resection of bone.

Tetracycline as an Aid to the Excision of Nidus in Osteoid Osteoma

Tetracycline as an Aid to the Excision of Nidus in Osteoid Osteoma