Treatment Of Osteoid Osteoma Research Articles

Letter To The Editor: An Unusual Complication of Radiofrequency Ablation Treatment of Osteoid Osteoma

Letter To The Editor: An Unusual Complication of Radiofrequency Ablation Treatment of Osteoid Osteoma

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.

P137. Minimally Invasive Surgery for Ablation of Osteoid Osteoma of the Spine

BACKGROUND CONTEXT: Given its success in the treatment of osteoid osteomas of the extremities, percutaneous radiofrequency ablation may offer a useful approach to such tumors involving the spine. Similarly the success of percutaneous transpedicular vertebral biopsy suggests its potential role in the treatment of osteoid osteoma of the spine.

Case Reports: An Unusual Complication of Radiofrequency Ablation Treatment of Osteoid Osteoma

Osteoid osteoma is a benign bone tumor traditionally treated nonoperatively or by operative excision. However, radiofrequency ablation is being used increasingly for treatment, as there are several reports supporting its effectiveness. Radio-frequency ablation is precise, minimally invasive, safe, effective, and associated with minimal complications and reduced use of healthcare resources. We report a patient treated with radiofrequency ablation for tibial osteoid osteoma and thermal necrosis of the skin.

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.

Percutaneous radio-frequency ablation of chondroblastoma: an effective alternative

Percutaneous radiofrequency ablation is a well known treatment for osteoid osteomas. But its use in treating chondroblastoma is not well established in literature. There have been few case reports of such treatment in recent radiology literature (Radiology 221(2):463–468, 2001; Eur Radiol 3:1–7, 2005). We report a case of chondroblastoma in proximal humerus in a 14 year old treated with percutaneous radiofrequency ablation. At 6 month follow up the patient was asymptomatic. A repeat CT showed evidence of healing including resolution of the tumeral calcification. Repeat biopsy at this time showed no evidence of tumour recurrence. This minimally invasive treatment is an effective alternative to surgical curettage and packing, and should be considered the treatment of choice for suitable lesions.

Cost comparison of low-field (0.23 T) MRI-guided laser ablation and surgery in the treatment of osteoid osteoma

The purpose of this study was to analyze the costs of magnetic resonance imaging (MRI)-guided laser ablation and to compare them with the costs of surgery in the treatment of osteoid osteoma. Seven patients with osteoid osteoma were treated with MRI-guided interstitial laser ablation during 1 year. The reference material consisted of six patients whose osteoid osteoma was treated surgically by either superficial or deep excision with metallic fixation. The costs were analyzed by using activity-based cost accounting. The mean cost of the MRI-guided laser ablation was 2,392 euros and of the excision of superficially located osteoid osteoma 1,807 euros. The cost of excision of deeply located osteoma with metallic fixation was considerably higher (4,996 euros). This was due to the higher material, personnel, and ward costs. The cost of MRI-guided laser ablation of osteoid osteoma was higher than the cost of surgical excision of a superficial osteoma but considerably lower than the cost of excision of a deeply located osteoma where metallic fixation was needed. When the number and mean cost of sick days or days of restricted weight bearing were also included, the cost of MRI-guided laser ablation was lower than the costs of either superficial or deep excision.

Percutaneous Minimally Invasive Therapies in the Treatment of Bone Tumors: Thermal Ablation

Many percutaneous image-guided ablative techniques have been utilized in the treatment of bone cancers. These techniques are fast becoming a focus in the treatment of patients with both benign and malignant forms of bone cancer. This article will review the principles of radiofrequency ablation including its use in combination with other therapies, cryoablation, and microwave ablation in the treatment of osteoid osteomas and bone metastases.

Percutaneous CT-guided curettage of osteoid osteoma with histological confirmation: a retrospective study and review of the literature

Osteoid osteoma is a benign bone tumour usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal), which can be alleviated by salicylates. Treatment consists of surgical excision or destroying the nidus and it is curative. In the past, surgery was performed in an "open" fashion and the nidus had to be removed with a bone block. This extensive type of surgery could be associated with some rates of both failure and complication. There is growing evidence to suggest that percutaneous CT-guided removal or destruction of the nidus is a good alternative and it is indeed gaining worldwide popularity. We present a series of 18 consecutive patients with osteoid osteoma of the pelvis, femur, and tibia, treated percutaneously under CT guidance. Removal of the nidus was performed using a 4.5-mm cannulated drill and a cannulated curette of our own design. Tissue samples for histological evaluation were obtained in the same way. The mean follow-up time was 29 months. Sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful (primary and secondary success rates 88 and 100% respectively). The diagnosis was histologically confirmed in 14 cases out of 18 (77%). In four cases no histological confirmation of osteoid osteoma could be achieved. There were only two minor complications, one case of femoral neuropraxia and one case of skin abrasion. Percutaneous CT-guided removal seems to be efficient and safe for the treatment of osteoid osteoma. The use of a cannulated drill and a cannulated curette facilitates efficient removal of the tumour and procurement of tissue for diagnosis.

Osteoid Osteoma Treated with Computed Tomography—Guided Percutaneous Radiofrequency Ablation: A Case Series

The nidi of osteoid osteoma are small and difficult to identify precisely; this can necessitate substantial resection of the surrounding normal bone. We applied percutaneous, image-guided radiofrequency ablation to treat 5 patients with osteoid osteoma. The precise location of each nidus was determined using a 3-mm-thick spiral computed tomographic scan. The most appropriate needle pathway was selected to avoid major neural and vascular structures. A 14-gauge core needle was introduced into the nidus and then exchanged for a 17-gauge straight rigid electrode with a 1-cm exposed tip to heat the lesion to 90 degrees centigrade for 5 minutes. Four of the 5 patients were discharged on the day after surgery without any external supports, and were pain-free after a few days. The remaining patient had a pes equinus contracture induced by the penetration of the calf muscles through a posterior approach but was fully recovered 6 days later. The mean follow-up period was 20.6 months. No recurrences or late complications were observed in this series. This case series shows that the computed tomography-guided percutaneous radiofrequency ablation is a simple, minimally invasive, and highly effective technique for the treatment of osteoid osteoma.

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.

CT guided radiofrequency ablation of intra-articular osteoid osteoma of the hip

Osteoid osteoma is a painful benign bone tumour. Previously the standard therapy was surgical excision. Image guided radiofrequency ablation can be clinically applied to ablate the tumour in a minimally invasive manner. We present a case of an 18-year-old boy who presented with features of chronic left hip arthropathy secondary to intra-articular osteoid osteoma, subsequently successfully treated by percutaneous CT guided radiofrequency ablation. The CT guided radiofrequency ablation was technically successful as a day case procedure without complication. The patient returned to normal function within one week. No recurrence occurred in the three-year follow-up period. Radiofrequency ablation is a safe, minimally invasive and effective technique for treatment of osteoid osteoma.

Thermocoagulation percutanée scannoguidée de l’ostéome ostéoïde

Purpose of the study Progress in Medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. Material and methods We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. Results Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. Discussion and conclusion This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

Minimally invasive therapy for osteoid osteoma

We describe a minimally invasive procedure for the treatment of osteoidosteoma and present the outcome of the treatment in our collective. Additionally, a review of the literature for minimally invasive therapy for osteoidosteoma was performed. Within approximately three years, ten male patients with the clinical and radiological diagnosis of osteoidosteoma were treated. First, during the procedure for the purpose of orientation, a CT scan of the affected area was performed. Then, under CT-guidance, the nidus of the osteoidosteoma was marked with a k-wire and destroyed with a drill, moulding cutter or the k-wire. The patients' charts and films were reviewed in a retrospective manner, all patients participated in a personal telephone interview. In all cases the intraoperative course was free of complications. After surgery 90 % of the patients were free of pain, in 10 % a significant reduction of the pain was reported. Both in those 10 % and the whole collective there were no clinical symptoms of relapse, the average follow-up in all cases was 19 months. Our results are in accord with data in the literature. In our collective the CT-guided, percutaneous removal of osteoidosteoma has been shown to be a safe and effective method. Under DRG conditions it can be performed within a short period of hospitalization or in the out-patient clinic.

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.

The role and limitations of radiofrequency ablation in treatment of bone and soft tissue tumors.

Percutaneous radiofrequency ablation (RFA) has evolved as an alternative therapy for treatment of certain patients with liver tumors. This novel image-guided intervention is a minimally invasive form of therapy with negligible morbidity. RFA has also been used for treatment of selected patients with renal and lung malignancies who may not be suitable surgical candidates. With the exception of osteoid osteomas, surgical management remains the treatment of choice for primary bone and soft tissue tumors. The role of RFA in definitive treatment of sarcomas has not been investigated. However, RFA has replaced surgery for treatment of osteoid osteomas and can play a role in palliation of painful bone and soft tissue tumors.

Osteoid osteoma--ten-years' experience in therapy

To review ten-years experience in diagnostics and operative treatment of osteoid osteoma. A total of 15 patients were retrospectively analyzed in this study. Clinical diagnosis was based on medical check-up, aspirin test, and conventional laboratory and radiographic examinations. CAT scan radionuclide bone scan, and magnetic resonance were performed in certain cases. All the patients were operatively treated by local resection of the tumor-infested bone. The resected part of the bone was intraoperatively checked by X-ray. The aim of this examination was to verify nidus in the resected bone. Afterwards, the resected bone with nidus was histologically analyzed. Osteoid osteoma was histologically verified in 86.6% of cases. Other forms of bone tumors were verified in 13.3%. In the early postoperative period patients were without previous discomforts. Future treatment consisted of regular medical check-up of all the patients. In order to verify the final results, in February 2002 another medical check-up was performed for 11 patients, upon their consent. All of the patients with verified osteoid osteoma were without discomforts. Medical findings were regular in each case. Conventional radiography showed a solid bone remodelling in place of resected bone. Osteoid osteoma is a benign bone tumor with typical clinical and radiographic findings. Operative treatment represents a method of choice and demands accurate preoperative localization of the lesion, with the help of computer-assisted tomography.

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.

Gamma Probe Localization in the Surgical Treatment of Osteoid Osteoma

Osteoid osteoma is a benign bone tumor typically inducing night pain. It has traditionally been treated with operative excision. An accurate localization and complete removal of the small lesion is difficult resulting in high recurrence rate and reoperations. The purpose of the present study was to examine the applicability of a hand-held gamma probe in the intraoperative localization of an osteoid osteoma. Five patients were examined and operated for osteoid osteoma. Dose of 740 MBq Technetium 99m was injected 3 hours before operation, and hand-held gamma probe was used for the intraoperative detection of the lesion. All patients were relieved their symptoms. A histologically confirmed, complete removal of the lesion was achieved in 4 of 5 patients. No recurrences has been seen in the follow-up of 6 years. The gamma probe is an useful tool in the surgical treatment of osteoid osteoma. The technique is rapid and simple resulting in more accurate excision of the small lesion.

Percutaneous Laser Photocoagulation of Osteoid Osteomas under CT Guidance

AIM: The aim was to evaluate laser photocoagulation and the use of the Bonopty needle system in the treatment of osteoid osteoma. MATERIALS AND METHODS: Five patients with osteoid osteomas were treated with computed tomography (CT)-guided, percutaneous laser photocoagulation using the Bonopty biopsy system. RESULTS: Complete pain relief was obtained in four patients. In one patient, pain persisted until the 6 weeks follow-up but resolved within 24 h of repeating the procedure. There were no complications, and patients remained symptom free at follow-up of 4–23 months (mean, 14 months). CONCLUSION: CT-guided laser photocoagulation of osteoid osteoma is a minimally invasive technique that represents a cost-effective alternative to surgical excision. The Bonopty needle system allows successful penetration of the sclerotic bone surrounding the nidus with manual pressure alone.