Osteoid Osteoma In Children Research Articles

Advantages and disadvantages of methods of visualization in the surgical treatment of osteoid osteoma in children

Advantages and disadvantages of methods of visualization in the surgical treatment of osteoid osteoma in children

CT-guided radiofrequency ablation of painful intra-articular osteoid osteoma in children: Is there a concern for cartilage damage?

To evaluate the safety and efficacy of computed tomography-guided percutaneous radiofrequency ablation (PRFA) in the management of uncommon and technically challenging intra-articular osteoid osteoma in children. From December 2018 to September 2022, 16 children with intra-articular osteoid osteoma, including ten boys and six girls, were treated at two tertiary centers with percutaneous CT-guided RF ablation using a straight monopolar electrode. The procedures were carried out under general anesthesia. Post-procedural clinical outcomes and adverse events were assessed through clinical follow-up. Technical success was achieved in all of the participating patients. Clinical success with relief of symptomatology throughout the period of follow-up was achieved in 100% of the patients. No persistence or recurrence of pain occurred during the follow-up period. No immediate or delayed adverse effects were observed. PRFA is shown to be technically feasible. Clinical improvement can be achieved with a high rate of success in the treatment of children with difficult-to-treat intra-articular osteoid osteomas.

Proximal femur osteoid osteoma in children: Diagnosis and management: A case series

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

IMAGING FINDINGS OF OSTEOID OSTEOMAS IN CHILDREN AND ADOLESCENTS, CT VERSUS MRI: A SINGLE CENTER EXPERIENCE

Objective: To analyze osteoid osteomas of the pediatric age group, assess the distribution of lesions, and radiological findings, and compare the ability of Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) in detecting the tumor.Material and Methods: Forty-four lesions of osteoid osteoma in children and adolescents were retrospectively analyzed using hospital files and institutional picture archiving and communication systems. Age, gender, treatment choices, modality used for diagnosis, tumor site, location within the bone, presence of calcified nidus, perilesional reactive sclerosis, cortical thickening, perilesional bone marrow edema, and joint effusion were documented.Results: Twenty-nine males and 15 females with a median age of 15.00 (range: 4-18 years) were included in the study. All of the lesions were located in the appendicular skeleton. No axial skeletal involvement was found. Forty out of 44 lesions were located in the long bones. One was localized in the patella, 2 of them in the talus and 1 in the calcaneus. Thirty-four out of forty long bone involvement were in lower extremities. Six cases were located intraarticularly and joint effusion was seen in the involved joint. CT was available in all patients and MRI was available in 18 patients. CT was the first choice of cross-sectional imaging modality in 35 patients, and MRI was the first choice in 9 patients. MRI was successful in only 56% of the cases in characterizing osteoid osteomas. CT was accurate to characterize all osteoid osteoma lesions.Conclusion: CT is more successful than MRI in detecting and characterizing osteoid osteomas. Intraarticular osteoid osteoma must be kept in mind in differential diagnosis, evaluating joint synovitis in children and adolescents.

Intra- and juxta-articular osteoid osteoma in children and adolescents.

BackgroundOsteoid osteoma (OO) is a common benign tumor in children and adolescents, but intra-and juxta-articular OO is rare and difficult to diagnose. The purpose of this study is to investigate the distinctions between intra- and juxta-articular OO, trying to avoid delaying diagnosis and optimize treatment strategies.MethodsThirty patients diagnosed with OO in the intra- and juxta joint at our institution who underwent surgical resection were included. Clinical and epidemiological factors, preoperative radiograph parameters, including computed tomography (CT), magnetic resonance imaging (MRI), and bone scan, were documented. The outcomes of the involved extremity were evaluated at the final follow-up.ResultsMean age at diagnosis, interval time, and follow-up time was 8.37±3.79 years old, 4.67±5.88 months, 3.57±2.18 years, respectively. Factors identified to be significantly associated with intra- and juxta-articular OO including pain with activity (P=0.004) and abnormal range of motion (P=0.00). The factor of abnormal range of motion (P=0.03) also influenced the existence of complications. Six children had a secondary operation to cure the recurrence.ConclusionsIt is essential for clinicians and radiologists to be aware of the atypical clinical and radiographic features of intra- and juxta-articular OO, as the delayed diagnosis can lead to unnecessary pain and further complications after surgeries. The pain with activity and abnormal range of motion is helpful to identify the location of OO. The persistently abnormal range of motion also significantly leads to complications. The open surgeries to resect the nidus in juxta-articular OO were effective.

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience.

To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children. Institutional database research identified 33 symptomatic patients (≤ 18years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1week, 1/6/12months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire. Mean lesion size was 8.28 ± 4.24mm. Mean follow-up was 23.33 ± 17.61months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications. The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Magnetic-resonance-guided focused ultrasound treatment of non-spinal osteoid osteoma in children: multicentre experience.

Osteoid osteoma is a benign and painful musculoskeletal tumour that usually affects children. Current standard treatment is CT-guided radiofrequency ablation, a minimally invasive percutaneous procedure, with clinical success rates ranging between 85% and 98%. Though minimally invasive, however, this type of procedure is not free from complications. To investigate the efficacy and safety of magnetic resonance (MR)-guided focused ultrasound (MRgFUS), a needleless procedure of thermal ablation employed in the treatment of non-spinal osteoid osteoma in paediatric patients. We report the results of 33 procedures of ablation of osteoid osteoma performed with MRgFUS in three university hospitals. To ablate a lesion on the bone surface, MRgFUS employs the ultrasound energy transduced along the soft tissue. The follow-up studies lasted 24months and were performed combining clinical and imaging data. Mean age of the children was 13.8years. The clinical outcome showed a primary success of 97%. One case alone was submitted to repeat treatment because the first one failed (secondary success). No major or minor complications were recorded. During the investigation time, no relapse of symptomatology or delayed complications were observed. Although our study is preliminary and limited by a low number of patients, our data show that MRgFUS is effective. This suggests that it might be useful as the first-line treatment in paediatric patients with osteoid osteoma.

Neurophysiological Monitoring in Radiofrequency Ablation of Spinal Osteoid Osteoma With a Progressive Time and Temperature Protocol in Children

Study DesignRetrospective. Level IV Evidence. ObjectiveTo assess the utility of intraoperative neurophysiological monitoring (IONM) to detect and eventually prevent impending neurovascular damage during computed tomography (CT)-guided radiofrequency ablation (RFA) of spinal osteoid osteoma (OO) in children. Summary and Background DataTo our knowledge, this is the first case series of spinal OO in pediatric patients treated at a single center employing IONM during RFA. MethodsThis is a retrospective study of seven consecutive patients (3 girls and 4 boys, mean age: 9 years 4 months) with imaging and clinical signs compatible with spinal OO who underwent CT-guided RFA, under general anesthesia, and IONM in a single center between 2011 and 2015. Before the RFA procedure, a CT-guided percutaneous biopsy of the nidus was performed in the same setting. RFA was divided into four cycles of increasing time and temperature and performed under IONM in every patient. ResultsTwo patients had lesions located in the thoracic spine and five patients had lumbar involvement. The RFA technical and clinical success was 85.7%. Six patients presented with reversible neurophysiological changes either during biopsy needle positioning or RFA cycles. In the remaining case, as IONM changes did not improve after several minutes of neuroprotective hypertension, the procedure was interrupted. Neither neurologic nor vascular complications were observed after RFA treatment. In only one biopsy sample, OO was confirmed by histopathologic studies. ConclusionCT-guided RFA is an accepted minimally invasive technique for the treatment of spinal OO in children. IONM may be a helpful tool that requires minimal additional time and provides feedback on the state of the spinal cord and nerves at risk during the procedure. We promote the use of IONM during these procedures to detect and possibly prevent impending neurologic damage. Level of EvidenceLevel IV.

Abstract No. 213 - Changing paradigm for treatment of osteoid osteoma in children

Abstract No. 213 - Changing paradigm for treatment of osteoid osteoma in children

Magnetic resonance guided focused ultrasound for noninvasive pain therapy of osteoid osteoma in children

Osteoid osteoma (OO), a small painful benign bone tumor, is the most common bone tumor in children. Pain is managed with nonsteroidal anti-inflammatory drugs but minimally invasive techniques, such as CT-guided laser ablation, have become a standard intervention. However, the potential for non-target injury is a concern as tissue temperature cannot be measured with CT and the laser induces temperatures >90°C for 10 minutes. It also includes risks from exposure to ionizing radiation, fracture, infection and transmitted thermal damage from the access needle. Magnetic resonance guided high intensity focused ultrasound (MRgHIFU) has been used successfully in small cohorts of adults with OO. The noninvasive nature of the energy means that procedures do not need to be conducted in a sterile environment since there is no mechanical penetration of the bone, reducing the chance of pathologic fracture and infection.

Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil.

ObjectiveTo report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma.Materials and MethodsThe medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure.ResultsClinical follow-up was available for all cases at a median of 29 months (range 6–60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%).ConclusionCT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus.

CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study

The purpose of this study was to evaluate the safety and efficacy of CT-guided percutaneous cryoablation for osteoid osteoma in children. This study was approved by the institutional ethics committee. From January 2007 to July 2008, six children (four boys, two girls, mean age 12.6 years old) with osteoid osteoma were treated with CT-guided percutaneous cryoablation. The procedures were carried out under conscious sedation and local anesthesia. CT guidance was used for procedural planning, instrument guidance, and monitoring. An argon-based cryoablation system was used. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome for a minimum of 12 months. A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with a t-test. The mean clinical follow-up period was 28.7 months (ranging from 18 to 36 months). Cryoablation was technically and clinically successful for all patients. No major immediate or delayed complications were observed. Significant pain relief (P <0.05) was observed in all patients after operation. Mean VAS were 6.57 ± 0.55 pre-procedure and 0.57 ± 0.10 1 month post-procedure. Patients were allowed to fully bear their weight and function without limitation within 3 days after the procedure. Pain recurrence was not observed in any patient. Percutaneous cryoablation is safe and effective for the treatment of osteoid osteomas in children. Notably, this procedure can be accomplished without general anesthesia.

Arthroscopic Excision of Osteoid Osteomas of the Hip in Children

The atypical presentation of intra-articular osteoid osteoma in the hip joint frequently results in delayed diagnosis compared with the diagnosis of extra-articular osteoid osteoma. We present 2 cases of hip joint osteoid osteoma in children treated by hip arthroscopy. Intra-articular osteoid osteoma was suspected when computed tomography (CT) findings were reviewed. Of the various surgical options including wide-open or CT-guided minimally invasive techniques, arthroscopic excision was selected for our patients to avoid damage to the adjacent growth plate (the triradiate cartilage) and to treat concomitant synovitis. Under arthroscopic visualization, biopsy specimens were obtained first, and the lesions were excised. In both cases, postoperative CT showed complete excision and histologic examination confirmed the diagnosis. Both patients enjoyed excellent clinical outcomes. We conclude that the arthroscopic excision of the hip joint osteoid osteoma in children is effective because it causes minimal damage to normal bone or the adjacent growth plate, and because synovectomy for concomitant synovitis may be performed. Hip arthroscopy also yields a biopsy specimen adequate for pathologic examination.

Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children

Sir, We read with a great deal of interest the article by Donkol et al. “Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children” [1] that describes the authors’ experience in treating osteoid osteoma (OO) in 23 children. From June 2001 to now we have treated over 140 osteoid osteomas in children (age range 3–16 years; girl/ boy ratio 1:1.7). We fully agree with the authors regarding the advantages of radiofrequency ablation (RFA) for the treatment of OO in children. To avoid skin burns when the lesion is very superficial or involves small bones, besides placing the active tip in the bone, we put ice on the skin near the needle throughout RF delivery, and in addition, we use a low mA and two adhesive plates (10×15 cm) near the lesion. We have never had a case of hyperthermia. Our patients resume normal daily activities around 12 h after the thermal ablation procedure, with the exception of sport that is resumed after 3 months. The patients usually need no further treatment at home. The diagnosis is based on the correlation of history, clinical examination, and radiological data (conventional radiographs, CT, MRI). We hardly ever perform scintigraphy (to avoid further radiation exposure). When possible, we also prefer to use spinal rather than general anaesthesia, although in very small or uncooperative children there is no choice. Antibiotic (cefazolin 1–2 g) is administered intravenously as a single dose during the procedure. We use a coaxial system formed by the 14-G Bonopty needle biopsy set (Radi, Uppsala, Sweden) after inserting an 18-G needle and Kirschner wire (0.8 mm) as a guide. The needle electrode and the generator are the same type as used by Donkol et al., and we use three different lengths of active tip (5, 10, and 15 mm) according to the dimensions of the lesion. Before delivering the RF we always perform a biopsy and only then insert the needle electrode. The delivery temperature never exceeds 95°C. The procedure time is approximately 20–30 min. We agree with the Donkol et al. regarding the greater risk of recurrences in children, which we think might be because of the greater “skeletal activity”. Despite this high recurrence rate, albeit lower than that reported in the literature for surgical treatment, we believe that thermal ablation of OO with RFA should be considered the gold standard for children as well as adults.

Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children

Percutaneous radiofrequency (RF) ablation of osteoid osteoma has high technical and clinical success rates. However, there are limited data on its use in the treatment of osteoid osteoma in children. To assess the safety and efficacy of CT-guided percutaneous RF ablation of osteoid osteoma in children and compare the outcomes with published data on its use in patients unselected for age. From January 2003 to July 2006, 23 children with osteoid osteoma were treated with CT-guided RF ablation using a straight rigid electrode. Their mean age was 11 years (range 3.5-16 years) and there were 15 boys and 8 girls. The procedures were carried out under general anaesthesia. Follow-up was performed to assess technical and clinical outcome. The mean follow-up period was 2.5 years (range 13-49 months). Technical success was achieved in 21 children (91.3%). Failure occurred in two children, in one due to failure to adequately localize the nidus within the dense sclerosis and in the other because of a short ablation time (2 min) because he developed hyperthermia. Clinical success was achieved in 18 patients within 2-5 days (primary clinical success rate 78.2%).These patients were allowed to fully weight-bear and function without limitation 1 week after the procedure. Pain recurrence was observed in two patients; one was treated successfully with a second ablation after 6 months (secondary clinical success rate 82.6%). Hyperthermia was observed in two patients during the procedure. Three other minor complications were observed: wound infection in one child and skin burn in two children. No major immediate or delayed complications were observed. Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children. It has high technical and clinical success rates that are slightly lower than those of patients with a wider range of ages.

The Diagnostic Accuracy of MRI Versus CT Imaging for Osteoid Osteoma in Children

The Diagnostic Accuracy of MRI Versus CT Imaging for Osteoid Osteoma in Children

Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients

Osteoid osteoma is a painful, benign, small osteogenic bone tumor. For a long time, surgery was the only treatment for these lesions. Different minimally invasive therapeutic techniques have been proposed. We report our experience in the treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children. Over a 5-year period, 18 patients (age range 6-17 years, mean age 11.6 years) with osteoid osteomas (femur, n=10; tibia, n=5; humerus, n=2; vertebral body, n=1) were treated with this technique. All procedures were performed under general anesthesia. All procedures were technically successful. Clinical success was achieved in 94.5% of patients (17/18). Only one patient had recurrence of symptoms 8 months after percutaneous resection and was surgically retreated. There were no complications. CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients.

The Diagnostic Accuracy of MRI versus CT Imaging for Osteoid Osteoma in Children

The Diagnostic Accuracy of MRI versus CT Imaging for Osteoid Osteoma in Children

The Diagnostic Accuracy of MRI versus CT Imaging for Osteoid Osteoma in Children

Advanced imaging often is obtained in children suspected of having osteoid osteoma. We hypothesized that magnetic resonance imaging gives a falsely aggressive appearance and that computed tomography is better for identifying osteoid osteoma. This is the first prospective blinded study comparatively assessing these imaging studies in children. Twelve preoperative magnetic resonance imaging scans of confirmed cases of osteoid osteoma were collected. Three radiologists blinded to the diagnosis reviewed these images. Only a clinical history of skeletal pain was given. Lesions were classified as benign-latent, benign-aggressive, or malignant. Radiologists were asked to list their primary diagnosis (with a confidence level from 1-10). Seven of these 12 children also had computed tomography scans that subsequently were reviewed in similar manner. With computed tomography scans, lesions were accurately identified as benign-latent (15/21 readings, 71%) and as osteoid osteoma (14/21 readings) more frequently than with magnetic resonance imaging scans (7/36 readings, 19%). Diagnostic study, Level III-1 (study of nonconsecutive patients--no consistently applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents.

The purpose of this paper was to evaluate the effectiveness of percutaneous radiofrequency ablation of osteoid osteoma in children and adolescents. Twenty-three patients aged 4.5-19.5 years were retrospectively reviewed. All patients with lower limb lesions were able to bear full weight on their operated limb immediately after the procedure, and to resume their daily activities within 24-48 h. Pain disappeared immediately after surgery in 21 cases, and in lower limb lesions the gait was back to normal after an average of 5 days. No septic or neurovascular complications were observed. At an average follow-up of 3.5 years, all the patients including two cases of initial failure were free of pain and had a normal gait. Clinical healing was confirmed by computed tomography and bone scan performed in 12 cases. This precise and minimally invasive method is safe, effective and associated with reduced health care resources. It could be recommended as the treatment of choice for osteoid osteoma of the limbs in children and adolescents.