Osteoid Osteoma Research Articles

Microwave Ablation of Spinal Osteoid Osteoma—Role of Air Insulation

AbstractOsteoid osteomas are benign tumors seen in children and young adults. The management options include surgical resection and percutaneous ablation. In the present scenario, percutaneous ablation is the preferred modality, as it is minimally invasive, safe, and reliable. However, when the tumor is near a heat-vulnerable structure, thermal injury can occur.We report the case of spinal osteoid osteoma in a young female that was treated by microwave ablation (MWA) with air insulation to prevent heat injury to the spinal cord. Currently, there is paucity of literature describing the use of air insulation with MWA. In this report, we describe the technique, advantages, and limitations of using air insulation with MWA.

Osteoid osteoma of the quadrilateral surface of the medial wall of the acetabulum treated with the anterior intrapelvic approach

Acetabular osteoid osteoma is very rare entity. The author reports on a lesion in a 33-years-old lactating female after 12 months of delay in diagnosis. Its periarticular location on the quadrilateral surface of the medial wall and its proximity to the obturator neurovascular bundle made its accessibility by the available minimally invasive treatment options difficult and dangerous. Surgical access through the traditional hip approaches is infeasible. Stoppa intrapelvic approach allowed direct visualization and en bloc resection of the lesion. Pain disappeared immediately after surgery with rapid improvement of her function. Temporary traction obturator neuropraxia was the only complication encountered. Full functional recovery was detected after three months and continued till the latest one-year follow-up with no recurrence manifestations.

Focused Ultrasound for Pediatric Diseases.

Focused ultrasound (FUS) is a noninvasive therapeutic technology with multiple pediatric clinical applications. The ability of focused ultrasound to target tissues deep in the body without exposing children to the morbidities associated with conventional surgery, interventional procedures, or radiation offers significant advantages. In 2021, there are 10 clinical pediatric focused ultrasound studies evaluating various musculoskeletal, oncologic, neurologic, and vascular diseases of which 8 are actively recruiting and 2 are completed. Pediatric musculoskeletal applications of FUS include treatment of osteoid osteoma and bone metastases using thermal ablation and high-intensity FUS. Pediatric oncologic applications of FUS include treatment of soft tissue tumors including desmoid tumors, malignant sarcomas, and neuroblastoma with high-intensity FUS ablation alone, or in combination with targeted chemotherapy delivery. Pediatric neurologic applications include treatment of benign tumors such as hypothalamic hamartomas with thermal ablation and malignant diffuse intrinsic pontine glioma with low-intensity FUS for blood brain barrier opening and targeted drug delivery. Additionally, low-intensity FUS can be used to treat seizures. Pediatric vascular applications of FUS include treatment of arteriovenous malformations and twin-twin transfusion syndrome using ablation and vascular occlusion. FUS treatment appears safe and efficacious in pediatric populations across many subspecialties. Although there are 7 Food and Drug Administration-approved indications for adult applications of FUS, the first Food and Drug Administration approval for pediatric patients with osteoid osteoma was obtained in 2020. This review summarizes the preclinical and clinical research on focused ultrasound of potential benefit to pediatric populations.

ROLE OF MRI IN EVALUATION OF MUSKULOSKELETAL TUMOURS

INTRODUCTION: Magnetic resonance imaging is a useful technique in the detection, evaluation and staging of the musculoskeletal tumours. Its excellent soft tissue contrast and its capability to image in multiple planes provides signicant superiority over the other imaging techniques. AIMS AND OBJECTIVES: The main aim of study was to assess the role of magnetic resonance imaging in diagnosis, management and follow up of musculoskeletal tumours. MATERIALS AND METHODS: The study was conducted on 50 patients suspected of musculoskeletal tumors referred to the Department of Radiodiagnosis, at MMIMSR, Mullana. All the studies were conducted on PHILIPS MULTIVA 1.5T and PHILIPS ACHIEVA 1.5T MRI machine which included T1 W turbo spin echo, T2W turbo spin echo and STIR/PDFS sequences. RESULTS: The result of the study showed that tenderness was the most common presenting complain seen in 46/50 cases (92.0%) followed by pain in another 45/50 cases (90.0%). In the current study 22 cases (44%) were found to be involved by benign lesions and 28 cases (56%) were found to be involved by malignant lesions. Among the benign osseous tumors, osteoid osteoma constituted 5/13 (38.4%) of cases, followed by osteochondroma 2/13 (15.3%) of cases. Majority of the malignant osseous tumors were ill dened lytic lesions with a wide zone of transition, with cortical breech and aggressive periosteal reaction. CONCLUSION: The study concluded that MR imaging has become a premier imaging modality to detect musculoskeletal tumors because of its excellent soft tissue contrast, its sensitivity to bone marrow & soft tissue oedema.

Interventional Radiology's Osteoid Osteoma Management: Percutaneous Thermal Ablation.

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate.

Open Surgical Hip Dislocation for an Acetabular Osteoid Osteoma - A Case Report

Osteoid osteoma is a benign tumor that accounts for roughly 10-12% of all benign bone forming tumors. This tumor generally occurs within the first three decades of life and occurs more commonly in males. This lesion is painful and is generally worse at night and has relief of symptoms with the use of NSAIDs. Osteoid osteoma is characterized by the production of osteoid surrounded by a rim of sclerotic bone. These lesions most commonly occur in long bones such as the proximal femur, however they can occur anywhere. Rarely, as with our patient, have these lesions been reported in the acetabulum.

Osteoid Osteoma of The Frontal Sinus: A Case Report

An osteoid osteoma is a benign bone-forming tumor that usually causes nocturnal severe pain. The majority are found in the head and neck region and represent the most common benign neoplasm of the nose and paranasal sinuses. We report the case of a 14-year-old female patient admitted for refractory headache and diagnosed with an osteoid osteoma of the frontal sinus, which have been treated successfully using surgical intervention. As for our patient, en block wide excision was enough to resect the whole tumor as it was confined to the frontal sinus.

Transnasal endoscopic approach for osteoid osteoma of the odontoid process in a child. Technical note and systematic review of the literature

Transnasal endoscopic approach for osteoid osteoma of the odontoid process in a child. Technical note and systematic review of the literature

An operative case presenting with radiculopathy due to osteoid osteoma in the pedicle of cervical spine

An operative case presenting with radiculopathy due to osteoid osteoma in the pedicle of cervical spine

Three cases of osteoid osteoma of foot

Three cases of osteoid osteoma of foot

Weakening or Structural Strengthening? An Evaluation of Bone Density after MRgFUS Ablation for Treatment of Benign Bone Lesions.

Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful osteoid osteomas and osteoblastomas in terms of bone density and morphological changes. We retrospectively evaluated patients treated at our institution with MRgFUS for superficial, painful osteoid osteoma or osteoblastoma during the last 9 years. Inclusion criteria were procedural and clinical success, as well as the availability of pre- and postprocedural CT examinations. Imaging features assessed were perilesional/nidus density changes and the occurrence of pathological fractures during the follow-up period. Our study population included 31 osteoid osteomas and 5 intra-articular osteoblastomas in 36 treated patients. We found an increased bone density of the lesions when pre and post-treatment CT- values were compared: these differences were statistically significant, and this finding is consistent with significant bone densification at the post-treatment imaging follow-up. No pathological fractures were observed after ablation during the follow-up. MRgFUS can be considered to be the treatment of choice for benign superficial bone lesions, thanks to its minimal invasiveness, excellent effectiveness, and safety. Pathological fractures, reported in literature as a rare event using needle ablation, never occurred in our MRgFUS treatment series.

Needleless Ablation of Osteoid Osteoma and Osteoblastoma: The Emergent Role of MRgFUS.

Osteoblastoma (OB) and osteoid osteoma (OO) are benign bone-forming tumors, with nearly identical basic microscopic features. The main difference is dimension (OO has usually a nidus measuring <2 cm in diameter). In addition, OB is biologically more active than OO, with a tendency to grow in size. Historically, treatments have included surgical resection and analgesics, although invasiveness and poor tolerance have led to the current standard of care moving toward interventional radiology, where radiofrequency ablation (RFA) represents the most diffuse technique. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has recently emerged as another innovative alternative treatment, providing tumor ablation through a needleless and ionizing radiation-free modality. In addition, this technique has the ability to guarantee a very precise and controlled increase in temperature, delivering small amounts of energy that can accurately destroy only the lesion, avoiding healthy surrounding tissues. The present review focuses on MRgFUS as the less invasive, safe, effective, and durable treatment option for the management of osteoid osteoma and osteoblastoma, including a description of technical details, indications and outcomes.

Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma

PurposeTo assess efficacy and safety of cone beam computed tomography (CBCT) in the radiofrequency ablation (RFA) of osteoid osteoma (OO) in children and adolescents, and to compare technical success, clinical success, radiation dose and procedure duration time of CBCT guidance to conventional computed tomography (CT) guidance.Materials and methodsBetween 2015 and 2019, 53 consecutive percutaneous RFA were performed on pediatric patients with CBCT or conventional CT guidance, respectively, in 24 and 29 children and adolescents with 24-month follow-up. Dose area product (DAP) and dose length product (DLP) were recorded, respectively, for CBCT and conventional CT and converted to effective doses (ED).ResultsCBCT and conventional CT groups were similar in terms of patient age and weight, tumor size and tumor location. Technical success was achieved in all cases. Primary clinical success was 91.67% (22/24) for the CBCT group and 89.66% (26/29) for the conventional CT group. Mean DAP was 64.75Gycm2 (range 6.0–266.7). Mean DLP was 972.62mGycm (range 337–2344). ED was significantly lower in the CBCT group compared to the conventional CT group (0.34 mSv vs. 5.53 mSv, p = 0.0119). Procedure duration time was not significantly longer in the CBCT group (102.25 min vs. 92.34 min, p = 0.065). No major complication was registered. Minor complications were observed in 4 patients (2 in CBCT; 2 in conventional CT).ConclusionsCompared to conventional CT guidance, CBCT guidance for percutaneous OO ablation shows similar technical and clinical success rates, with reduced radiation dose and equivalent procedure duration time. This technique helps sparing dose exposure to pediatric patients.

Arthroscopic Excision of Hamate Osteoid Osteoma.

Osteoid osteoma is considered the most common benign bone forming tumor accounting for 12% of all benign bone tumors. The carpus is a rare site for this tumor but quite a few cases were reported before. The lesion can be subperiosteal, cortical or medullary. Computed tomography scan is the gold standard diagnostic study, whereas magnetic resonance imaging can result in delaying the diagnosis as reported in the literature. Open excision with or without grafting was the technique of choice in most reviewed cases in the literature. In this paper we will illustrate a minimally invasive technique using wrist arthroscopy for an osteoid osteoma of hamate proximal pole. This minimally invasive arthroscopic technique provides a rapid recovery for patients with lesions that are accessible to wrist arthroscopy.

Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques.

Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary.

Monoarthritis of the Elbow Revealing Osteoid Osteoma: A Case Report and Literature Review

Osteoid osteoma is a rare benign osteoblastic tumor that mainly occurs in the extra-articular segments of lower limb long bones. The elbow is an exceptional location for osteoid osteoma.&#x0D; The diagnosis is usually delayed since the elbow is a rare site for this tumor and unspecific clinical signs, such monoarthritis, may mimic other more common conditions.&#x0D; We report the case of a 16-year-old girl who presented with chronic monoarthritis of the elbow which was treated falsely as tuberculous arthritis and monoarticular rheumatoid involvement.&#x0D; The laboratory tests were negative. Computed tomography scan and magnetic resonance imaging showed the focal nidus at the coronoid process of the ulna with mild synovitis. The diagnosis of osteoid osteoma was not made until the disease had been progressing for eighteen months and the elbow had already become stiff.&#x0D; Arthroscopic excision of the lesion was performed, and histopathology of the nidus was consistent with osteoid osteoma. Since then, the patient has been pain-free with an improved elbow range of motion.

Bone grafts versus synthetic bone substitutes in the treatment of benign bone tumors

Abstract Benign bone tumors represent an important chapter in the pathology of the musculoskeletal system, most commonly affecting young people under the age of 30. The most common benign bone tumors diagnosed in orthopedic surgery are: osteochondroma, osteoid osteoma, osteoblastoma, giant cell tumor, bone aneurysmal cyst, and fibrous dysplasia. An important feature is the lack of secondary determinations. Depending on the type and the location of the benign bone tumors, treatment can be non-surgical or surgical. Patients included in the study were between 25 and 55 years old with an average age of 40. In both cases, the radiological image remains the routine investigation in the periodic postoperative control. The purpose of this study was to compare the surgical treatment (curettage-filling) with synthetic bone substitute, compared to autograft in patients with benign bone tumors.

Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound.

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel noninvasive therapy that uses focused sound energy to thermally ablate focal pathology within the body. In the United States, MRgFUS is approved by the Food and Drug Administration for the treatment of uterine fibroids, palliation of painful bone metastases, and thalamotomy for the treatment of essential tremor. However, it has also demonstrated utility for the treatment of a wide range of additional musculoskeletal (MSK) conditions that currently are treated as off-label indications. Advantages of the technology include the lack of ionizing radiation, the completely noninvasive technique, and the precise targeting that offer unprecedented control of the delivery of the thermal dose, as well as real-time monitoring capability with MR thermometry. In this review, we describe the most common MSK applications of MRgFUS: palliation of bone metastases, treatment of osteoid osteomas, desmoid tumors, facet arthropathy, and other developing indications.

Clinical and Radiographic Features of Phalangeal Osteoid Osteoma

Clinical and Radiographic Features of Phalangeal Osteoid Osteoma

Osteoid Osteoma: Percutaneous CT-guided Cryoablation Is a Safe, Effective, and Durable Treatment Option in Adults.

Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.