Introduction: Osteoid osteoma is a benign painful bony lesion that often affects children and young adults. It is 3% of all bone tumors. It may result in growth disturbance, bony deformity, joint swelling and contractures. Long bones especially of the lower limb are the most commonly affected regions. During the initial period, the resection of nidus was performed by open surgery where a bone block was removed. This was followed by development of computed tomography (CT)-guided procedures for complete removal of nidus using various percutaneous techniques. These include CT-guided radiofrequency ablation (RFA) or trephination. If these lesions are near any important vascular structures, it becomes difficult to use RFA due to risk of injuring them. While the results of RFA are well studied, percutaneous trephination is still not widely researched. Objectives: We evaluated the results of 14 cases of osteoid osteoma treated with percutaneous drilling resection of the nidus under CT guidance and discussed the positive and negative impact of the same. Material and Methods: We included 14 patients who presented, from October 2017 to September 2020, at a tertiary level health care center. The diagnosis was established by clinical as well as imaging modalities. The patients underwent CT scan and the exact site was localized. Safe zone for percutaneous drilling was identified using contrast for vascular bundle. Percutaneous drilling was done using 8 mm reamer and complete lesion was removed under CT guidance. Patients were followed up for 2 years after the procedure and the final results were obtained in terms of pain, functional ability of limb and recurrence. Results: 13 out of 14 patients were pain-free at the end of the follow-up. One patient did have some pain after 1 year and on repeat imaging, there were changes suggestive of recurrence. The success rate was thus 13/14 patients (92.8%). The mean pre-operative pain score improved from 2.3 (range, 0–4) to 4.85 (range, 4–5) after procedure. There was no functional deficit of the limb recorded at the end of final follow up. Conclusion: CT-guided percutaneous trephination is a cost-effective alternative to available treatments protocols for Osteoid osteoma. Although newer techniques such as radio-frequency ablation are available, they are neither easily accessible nor affordable for the masses in developing countries.