Radiofrequency Ablation Of Osteoid Osteoma Research Articles

CT-guided percutaneous radiofrequency ablation in osteoid osteoma

CT-guided percutaneous radiofrequency ablation in osteoid osteoma

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.

Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy Delivery

Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy DeliveryUgo Albisinni, Rosanna Ciminari, Cristina Malaguti and Eugenio RimondiAudio Available | Share

Radiofrequency Ablation of Osteoid Osteoma in the Upper Extremity

Radiofrequency Ablation of Osteoid Osteoma in the Upper Extremity

MRI Features After Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy Delivery

MRI Features After Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy Delivery

Osteoid Osteoma: CT-Guided Radiofrequency Ablation Using a Water-Cooled Probe

The purpose of this study was to assess the safety and efficacy of computed tomography (CT) guided percutaneous radiofrequency (RF) ablation of osteoid osteoma by using the water-cooled probe. During the period from July 2002 to February 2006, fifty-one patients with osteoid osteomas localized in femur (29), tibia (10), calcaneus (2), talus (2), metatarsus (2), humerus (1), sacrum (1), scapula (1), olecranon (1), patella (1) and thoracic vertebra (1) were treated with CT-guided RF ablation using the Cooltiptrade mark Tyco Healthcare probe. Mean age was 20 (range, 3.5-57 years) and male to female ratio was 36/15. Mean follow-up period was reported 2 years (range, 9-51 months). The procedures were carried out under general anesthesia and the patients were discharged from the hospital within 24 h. Technical failure was reported in only one procedure. Pain disappeared postoperatively in all the patients within 2-3 days and no patients needed analgesic treatment after a week. All patients were allowed fully weight bear and function without limitation after the procedure. Recurrence of the pain was observed in one patient who was treated successfully with a second ablation. Our primary and secondary clinical success rates were 98 and 100% respectively. In one case, wound infection was observed after the procedure as the only post-operative complication in our series. CT-guided percutaneous RF ablation of osteoid osteomas using the water-cooled probe is a safe, effective and minimally invasive procedure with high success rate and lack of relapses.

Radiofrequency Ablation of Osteoid Osteoma: Initial Results with a Bipolar Ablation Device

To report the initial results with percutaneous radiofrequency (RF) ablation of osteoid osteomas with a bipolar ablation device. Twelve patients (seven male patients and five female patients; mean age, 17.3 years; age range, 6-36 y) with clinically and radiologically suspected osteoid osteoma were treated with computed tomography-guided percutaneous bipolar RF ablation. The procedure was performed with the patients under general anesthesia. After localization of the nidus, an 11-gauge hollow drill was introduced into the nidus through a 9-F introducer sheath. A bipolar 18-gauge RF probe with a 9-mm active tip was inserted through the introducer sheath and connected to the RF generator. Energy application was started at 2 W and subsequently increased to a maximum of 5 W. The procedure was terminated if a resistance of 900 Omega was reached. Mean duration of energy deposition was 8.3 +/- 4.0 minutes, with a mean energy application of 1.8 +/- 2.9 kJ (range, 0.3 - 7 kJ). In one patient, the intervention had to be repeated twice to achieve total pain relief. Eleven of 12 patients (92%) remained free of symptoms at a follow-up time of 15.1 +/- 9.5 months (range, 5 - 31 months). One patient had recurrence of pain 16 months after the procedure and was treated surgically. No complications occurred. Patients resumed normal activity within 24 hours. Percutaneous bipolar RF ablation is an efficient and safe treatment of osteoid osteoma. Short-term efficacy of bipolar RF ablation may rival the results of monopolar RF ablation. Further studies are needed to address the long-term efficacy of this technique.

Use of Ultrasonographic Guidance for Needle Localization of Osteoid Osteoma of the Capitate

Osteoid osteomas are benign small (typically less than 1.5 cm) osteoid-forming tumors accounting for 10–12% of all primary bone tumors. The most common sites are in the appendicular skeleton, but osteoid osteomas can occur in any bone. Classically, these tumors appear as a small sclerotic lesion with a circular lucent defect, the nidus. The nidus represents “osteoid and interconnected bone superimposed on highly vascularized connective tissue” [1, 2]. Treatment most commonly consists of medical management with nonsteroidal anti-inflammatory drugs (NSAIDs), surgical excision, and/or radiofrequency ablation. Fast scanning now made possible with multidetector computed tomography (CT) has resulted in CT-guided drilling (curettage or burr) and CT-guided percutaneous resection. More recently, there has been increased use of radiofrequency ablation of osteoid osteoma utilizing percutaneous guidance with CT [3–6]. This paper illustrates a case of an osteoid osteoma of the wrist, which was treated with surgical excision and radiofrequency ablation after needle localization under ultrasound guidance.

Percutaneous computed tomography-guided radiofrequency ablation of osteoid osteomas

Twenty-one consecutive patients with osteoid osteoma treated with computed tomography-guided radiofrequency ablation, after failed conservative treatment, were retrospectively reviewed. The diagnosis was based on typical clinical and imaging features. Radiofrequency ablation of osteoid osteomas was undertaken by heating the tip of the electrode to 90°C for three sessions of 2 min each. Follow-up evaluation included clinical examination and questionnaire, and radiographic evaluation was conducted on the first month, 12th month, and at the latest examination. Within the first 24 h post-procedure, pain was improved in all patients. Seven patients had pain relief within the first 3 days, 11 patients within the first week, and 3 patients within 2 weeks post-procedure. A month after the procedure, no patient had difficulty regarding self-care and daily activities. At a mean follow-up of 29 months (range 12–60 months), early or late complications and signs of local recurrence were not observed.

Percutaneous radiofrequency ablation for osteoid osteoma: experience with a new treatment

To review our experience with percutaneous radiofrequency ablation (RFA) for osteoid osteoma. Retrospective review of 24 patients with osteoid osteoma treated with percutaneous RFA at St Vincent's Hospital, Melbourne, from August 2000 to February 2005. Initial response to treatment, return of symptoms, time to recurrence, complications and histopathological correlation. In 23 of 24 patients, there was immediate relief of symptoms. One-third of patients had a return of symptoms. The 24 patients underwent a total of 32 RFA procedures. Of the eight patients who had a recurrence, five had an initial lesion > or = 10 mm in maximum diameter. Twenty-three of the 24 patients were pain-free at the end of the study period. Patients were followed up for a median of 26 months. There were no long-term complications. Percutaneous RFA is a safe and efficacious treatment for osteoid osteoma with a low morbidity rate. Despite recurrence after treatment, re-treatment is simple and effective.

Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy Delivery

Our objective was to evaluate the efficacy of percutaneous radiofrequency ablation of osteoid osteoma with cooled radiofrequency probes and impedance control energy delivery from a 200-W generator. We also compared the outcome to published data for therapy with a 5-mm noncooled probe and temperature-controlled short-duration therapy protocols. Radiofrequency ablation was performed on 11 patients with a clinical and radiologic diagnosis of osteoid osteoma. A cooled radiofrequency probe was introduced into the lesion under CT guidance. Twelve minutes of radiofrequency energy was delivered from a 200-W generator under impedance control. Postprocedural pain, function, and satisfaction were evaluated by means of an interview and questionnaire. All procedures were technically successful. No serious complication occurred. Postoperative pain was scored at a mean of 6.9 +/- 3.06 (95% confidence interval) on a numeric rating scale. Postoperative pain was rated as similar to night pain. By 1 week after therapy, all patients had resolution of pain and returned to normal activity. There was no recurrence during the follow-up period (range, 6-27 months; mean, 14.4 months). Patients rated their satisfaction as high. Radiofrequency ablation of osteoid osteoma with a high-energy delivery technique is safe and has a high success rate. When compared with patients in a published series using 5-mm probes and manual energy control from lower-output generators, our cohort showed increased postoperative pain scores and an increased interval to symptom resolution.

MRI Features After Radiofrequency Ablation of Osteoid Osteoma with Cooled Probes and Impedance-Control Energy Delivery

The purposes of our study were to determine the temporal changes in MR signal in bone after radiofrequency ablation of osteoid osteoma and the size of the zone of marrow signal change produced by the radiofrequency technique and to compare the size of the zone with published data for radiofrequency ablation with manual-control protocols. Radiofrequency ablation was performed in 10 patients with a clinical and radiologic diagnosis of osteoid osteoma. A cooled radiofrequency probe was inserted in the nidus. Twelve minutes of radiofrequency energy was applied from a 200-W radiofrequency generator in an impedance-control setting. MRI with multiplanar turbo spin-echo T1-weighted and STIR sequences was performed at 1, 7, and 28 days after the procedure in seven patients. The three remaining patients had follow-up imaging at 28 days only. The images were reviewed by two radiologists who categorized the imaging features and measured the marrow zone of signal alteration when visible. The size of the zone of marrow signal change produced by the radiofrequency technique was compared with published data for radiofrequency ablation with manual-control protocols. A 1-mm band of homogeneous altered marrow signal distributed symmetrically parallel to the entire probe tract was seen earliest, at 1 day, in the femoral neck lesion treated with the 2-cm probe. The band was low signal on the T1 sequence and high signal on the STIR sequence, and the diameter of the zone was 27 mm. By 7 days, five of the seven treated bones showed a band of marrow signal alteration. By 28 days, all 10 treated bones had a band of marrow signal alteration. The interband distance at 90 degrees to the probe measured on STIR images at 28 days was a mean of 20.9 mm (confidence interval, 16.1-25.7 mm [p < 0.05]; range +/- measurement error, 10.5-35 +/- 1.64 mm) with a 1-cm probe and 30.5 mm (measurement error, +/- 0.78 mm) on T1 images without contrast material when a 2-cm exposed-tip probe was used. Higher-output generators with impedance-control software and internally cooled radiofrequency probes with longer exposed tips produce larger zones of marrow signal change than expected with manual-control protocols. MRI allows detection of temporal marrow signal change after radiofrequency ablation. The marrow signal change with a high-energy delivery protocol is larger than manual-control protocols.

Radiofrequency Ablation of Osteoid Osteoma in the Upper Extremity

To examine the results of radiofrequency ablation (RFA) of osteoid osteoma in the upper extremity. Twenty-nine patients with a clinical and radiographic diagnosis of an upper-extremity osteoid osteoma were referred for treatment between 1990 and 2003. All had computed tomography-guided percutaneous RFA performed by the senior investigator. Records were reviewed for patient age and gender, lesion size and location, prior treatment, and pathology results. Outcomes were determined by questionnaire via mail or telephone. Complete success was defined as complete resolution of pain without further treatment. Partial success was defined as occasional pain with activities that did not require another procedure. Failure was defined as recurrence, no change in symptoms, and/or the need for another procedure. Follow-up data were available for 25 patients at a minimum of 1 year. Lesion locations included 17 humerus, 5 scapula, 2 radius, 1 ulna. Results for 19 patients were rated completely successful, 4 were rated partially successful, and 2 were rated failures. Two patients whose results were not completely successful received decreased RFA temperature or duration because of the proximity of a neurovascular bundle. There were no complications. Outcomes did not correlate with any patient or tumor characteristics. Radiofrequency ablation is a safe and effective treatment for most osteoid osteomas in the shoulder, arm, and forearm. Lesions that do not allow a safe distance between the electrode and a major neurovascular structure may require surgical excision. This may be of particular importance in lesions of the hand and carpus. Therapeutic, Level IV.

Magnetic Resonance Imaging Diagnosis and Computed Tomography-Guided Radiofrequency Ablation of Osteoid Osteoma

A 26-year-old male presented for magnetic resonance (MR) examination of the ankle for chronic ankle pain. MR images of the ankle revealed marked intraosseous bone marrow hyperintensity involving the talus on the fast inversion recovery sequence (Fig. 1). In addition, at the anteromedial margin of the posterior facet of the talus, a round, sclerotic lesion was present with an associated mild to moderate reactive synovitis in the subtalar joint (Fig. 1). Findings were consistent with an osteoid osteoma. Fig. 1 Selected magnetic resonance (MR) images of the hindfoot demonstrating the osteoid osteoma. Sagittal fast spin echo image (a) demonstrates the central nidus and peripheral rim of reactive sclerosis (arrow). Sagittal fast inversion recovery sequence (b ... Patient was referred for computed tomography (CT)-guided radiofrequency ablation of the lesion. Preprocedure CT images of the ankle again demonstrate the well-marginated sclerotic lesion in the posterior facet of the talus with a hypodense rim and centrally calcified nidus (Fig. 2). Fig. 2 Selected computerized tomography (CT) images of the hindfoot viewed with bone algorithm. Sagittal image (a), oblique coronal (b), and axial (c) images demonstrate the sclerotic central nidus of the osteoid osteoma (arrow) For the procedure, a radiofrequency probe was inserted into the lesion under CT guidance (Fig. 3). The probe was heated to 90°C for 6 min in the inferior and subsequently, the superior, portions of the lesion. The patient did well postprocedure. Fig. 3 Oblique coronal CT image taken during the radiofrequency ablation procedure with the patient in a lateral decubitus position, demonstrates the radiofrequency probe (arrow) centrally within the lesion

Radiofrequency Ablation in Osteoid Osteoma of the Finger

The occurrence of osteoid osteomas of the hand is rare and their treatment usually is surgical. A 26-year-old man with an osteoid osteoma in the proximal phalanx of the right middle finger was treated with percutaneous radiofrequency ablation. Two years later he remains free of pain and finger function is normal.

Percutaneous radiofrequency treatment of osteoid osteoma using cool-tip electrodes

Objectives To report our experience with percutaneous cool-tip radiofrequency ablation of osteoid osteomas and to evaluate clinical outcome. Methods and material Forty-one patients with clinically and radiologically suspected osteoid osteoma were seen over a 48-month period (27 males and 14 females with a mean age of 18.7 years; range 5–43 years). Thirty-eight patients were treated by computed tomography (CT)-guided percutaneous radiofrequency ablation. The procedure was performed under regional or general anaesthesia. After location of the nidus, a 14G-bone biopsy needle is introduced into the nidus. Sampling is performed with a 17G-bone biopsy needle using a coaxial technique. The radiofrequency needle with a 10 mm active tip (cool-tip) is inserted through the biopsy needle and is connected to the radiofrequency generator for 6–8 min. Results Primary success was obtained in 37 patients (97%) with a 100% secondary success rate. All patients are currently pain-free. No major complications occurred. Patients could resume unrestricted normal activity within 24 h. Conclusions Percutaneous radiofrequency ablation of osteoid osteomas is an efficient and safe method that can be considered the procedure of choice for most cases.

Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation

This article reviews current trends in the treatment of osteoid osteoma, with an emphasis on the evolving use of radiofrequency thermoablation as a primary definitive treatment and for recurrent and residual lesions. In so doing, the article reviews the merits and relative disadvantages of both surgical and nonsurgical imaging-guided techniques in treatment. Radiofrequency ablation of osteoid osteoma is a highly effective, efficient, minimally invasive and safe method of treating osteoid osteoma. Clinical success range from 76% to 100%. Surgery remains the standard treatment in cases where histology of the lesion is in doubt, neurovascular structures are within 1.5 cm or in repeated failure of any other minimally invasive ablative technique or percutaneous resection. Clinical success of surgery ranges from 88% to 100%. Laser interstitial thermal therapy shares many of the advantages and much of the success of radiofrequency thermoablation but has not been as available. Clinical success ranges from 87% to 100%. Cryotherapy, ethanol therapy and imaging-guided excision remain second-line therapies. Clinical success ranges from 77% to 100% for imaging-guided resection and 100% for ethanol therapy.

CT-guided radiofrequency ablation of osteoid osteoma: long-term results.

The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean +/- SD, 35.5+/-7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms.

Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation.

This article reviews current trends in the treatment of osteoid osteoma with an emphasis on the evolving use of radiofrequency thermoablation as a primary definitive treatment and for recurrent and residual lesions. In so doing, the article reviews merits and relative disadvantages of both surgical and non-surgical imaging-guided techniques in treatment. Radiofrequency ablation of osteoid osteoma is a highly effective, efficient, minimally invasive and safe method of treating osteoid osteoma. Clinical success range from 76 to 100%. Surgery remains the standard treatment in cases where histology of the lesion is in doubt, neurovascular structures are within 1.5 cm or in repeated failure of any other minimally invasive ablative technique or percutaneous resection. Clinical success of surgery ranges from 88 to 100%. Laser interstitial thermal therapy shares many of the advantages and much of the success of radiofrequency thermoablation but has not been as available. Clinical success ranges from 87 to 100%. Cryotherapy, ethanol therapy and imaging-guided excision remain second-line therapies. Clinical success ranges from 77 to 100% for imaging-guided resection and 100% for ethanol therapy.

Osteoid osteoma: percutaneous treatment with radiofrequency energy.

To report our experience with technical success, complications, and long-term clinical success of radiofrequency (RF) ablation of osteoid osteoma. After needle biopsy, computed tomography (CT)-guided percutaneous RF ablation was performed with general or spinal anesthesia. With an RF electrode, the lesion was heated to 90 degrees C for 6 minutes. Patient age and sex, lesion size and location, biopsy results, and complications were recorded. Clinical success was assessed at a minimum of 2 years after the procedure. Significance of patient age and sex and lesion location and size as a predictor of biopsy result was tested by means of chi2 analysis. In addition, effects of patient age and sex, lesion location and size, and biopsy results on clinical success were tested with the Fisher exact test. During an 11-year period, 263 patients who were suspected of having osteoid osteoma underwent 271 ablation procedures. All procedures were technically successful. There were two anesthesia-related complications (aspiration, cardiac arrest) and two minor procedure-related complications (cellulitis, sympathetic dystrophy). Results at biopsy were positive in 73% (197 of 271 biopsies). Two-year follow-up data were available for 126 procedures. The other procedures had been performed more recently or the patients could not be contacted. There was complete relief of symptoms after 112 of the 126 procedures (89%). For procedures performed as the initial treatment, the success rate was 91% (107 of 117 procedures). Procedures for recurrent lesions had a significantly lower success rate (six of 10 procedures [60%], P <.001). Clinical outcome was not dependent on biopsy result, patient age or sex, or lesion size or location. CT-guided percutaneous RF ablation of osteoid osteoma is a safe and effective technique.