Ostéome ostéoïde du lunatum: à propos d'un cas

The Osteoid Ostéome is a benign tumour which affects the young subjects and is electively located on the level of the long bones. We report a hyperalgic form of the lunatum in a young student with which surgical excision with bone-graft allowed the cure.

Une double localisation d'un ostéome ostéoïde du semi-lunaire

Osteoid osteoma is a small tumour, always benign, consisting of a small focus of osteoblastic hyperactivity surrounded by a zone of sclerosis. Located preferentially on the long bones, femur and tibia, carpal localisation is rare but if present it usually affects the scaphoid. We present a case of double localization of an osteoid osteoma in the lunate bone, presenting as gradually increasing pain in the wrist over the course of 18 months. Standard radiology and tomodensitometry of the wrist showed two central lucencies of the lunate without rupture of the cortex. Curettage of the lesion and packing of the resultant defect with cancellous bone resulted in disappearance of the lesions with good functional recovery. The clinical, radiological and therapeutic aspects will be discussed by the authors.

Intra-articular osteoid osteoma of the knee: clinical and therapeutical particularities

The intra-articular osteoid osteoma (10-13% of the cases) is often difficult to identify. They present frequent atypical clinical signs and radiological images that eventually lead to inadequate treatment. For example, it has been observed that this pathology leads to inappropriate arthroscopies (up to 40%). Meniscal tear and then osteochondritis were initially suspected on a patient with an intra-articular osteoid osteoma at the tibia level. For the treatment, any damage of the cartilage has to be avoided. Thermoablation with radiofrequency is the treatment of choice.

Percutaneous resection of a patellar osteoid osteoma using a cannulated skin punch biopsy needle

Patella is a very rare localization for osteoid osteoma. Non-specific knee complaints and difficulty to distinguish nidus in direct radiographs may cause a delay in diagnosis and make the definite diagnosis troublesome. The most effective and non-invasive method in treatment of osteoma is CT guided excision of the nidus. We present a case of patellar osteoid osteoma diagnosed by MRI scans. After being marked under CT guidance, the lesion was completely excised with a skin punch. We propose that, this method is both minimal invasive and effective in the management of patellar osteoid osteoma.

Osteoid osteoma of the dens axis

An osteoid osteoma of the dens axis was diagnosed by computed tomography and bone scintigraphy in a 14-year-old girl with a 1.5-year history of pain. No case of an osteoid osteoma of the dens axis has been published in the literature yet. Regarding its clinical and radiological appearance, this osteoid osteoma was essentially similar to osteoid osteomas in other locations, i.e., it had an osteolytic nidus surrounded by sclerosis, associated with nocturnal pain and a positive aspirin test.

[Osteoid osteoma of the wrist joint resembling tenosynovitis]

Osteoid osteoma of bones of the wrist joint is a relatively rare lesion. This article presents a series of three patients, one with osteoid osteoma of the styloid process of the radius and two with osteoid osteoma of the capitate bone. All of them had clinical symptoms resembling those of stenosing tenosynovitis of the wrist joint. X-rays, tomography and bone scan revealed the characteristic findings of osteoid osteoma. Histological examination confirmed the diagnosis. Treatment consisted of "en bloc" excision of these tumors. Following surgery patients were asymptomatic and had normal mobility of the affected wrist. In the first patient this has been maintained for the succeeding 27 years. It is suggested that in any case of persistent unexplained pain of the wrist or clinical symptoms resembling those of tenosynovitis, osteoid osteoma of the styloid process of the radius or of the carpal bones should also be included in the differential diagnosis. The recommended treatment of osteoid osteoma is "en bloc" excision of this tumour in the affected bone, resulting in complete relief of pain and absence of functional disturbances.

Osteoid osteoma of the patella. Case report and review of the literature

Osteoid osteoma is a benign, bone-forming tumor. The diaphyses of the long bones are the sites of predilection (at least 50% of all cases occurring in the femur and the tibia). Also this lesion has a male preponderance and the majority of cases present in the second and third decade. We represent an unusual localization of osteoid osteoma in the patella of a 51-year old woman.

[Sarcomatoid carcinoma with heterologous osteoid differentiation]

Sarcomatoid carcinomas of the bladder with heterologous osteoid differentiation are exceptional, aggressive tumors with a poor prognosis. We report a new case, and discuss the clinical and pathological characteristics of this tumor.

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

BACKGROUND

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.

OBJECTIVE

To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients.

[Image-guided minimal invasive surgical resection of osteoid osteomas of the long bones]

OBJECTIVES

In this prospective study, we evaluated the efficiency of image-guided minimal invasive surgical resection of osteoid osteomas of the long bones.

METHODS

Fourteen patients (11 males, 3 females; mean age 13 years; range 4 to 22 years) with osteoid osteoma of the long bones underwent image-guided minimal invasive intralesional extended curettage. Preoperatively, all the patients were evaluated by plain radiographs, computed tomography (CT), bone scintigraphy, and magnetic resonance imaging (MRI). Localization of the nidus was determined by measurements on thin-section (1-1.5 mm) CT scans and MR images and complete excision of the nidus was performed by image-guided minimal invasive technique. All the patients were evaluated by visual analog scale or faces pain scale to determine pain levels before and after surgery. The mean follow-up period was 17 months (range 13 to 31 months).

RESULTS

The mean visual analog scale scores were 7.9+/-1.2 (severe pain) and 0.3+/-0.6 (no pain) before and after surgery, respectively (p<0.05). Bone grafting or internal fixation were not required during operations. No perioperative or postoperative complications or recurrences were encountered. Early mobilization was possible in all the patients. At the final follow-ups, all the patients were asymptomatic and had full functional use of their operated extremities.

CONCLUSION

Image-guided minimal invasive surgery is effective in the local control of osteoid osteomas affecting the long bones and causes less morbidity. This technique also provides a good identification of the nidus intraoperatively.

Unusual localization of an osteoid osteoma

We report a case of a sternal osteoid osteoma in a 39-year-old man. This localization is very rare and to our knowledge not described in literature.

[Osteoid osteoma and radiofrequency]

Osteoid osteoma and radiofrequency Osteoid osteoma relates to a benign skeletal neoplasm, smaller than 2 cm in diameter, composed of osteoid, highly vascularized connective tissue and surrounded by a ring of bone sclerosis. Its aetiology remains unknown. It affects twice more males than female patients and occurs usually between 5 and 40 years old. Long bones and spine are the most involved areas but the whole skeleton can be involved. Clinical manifestations can include local pain (increased at night and decreased by activity) and relief with salicylates administration. CT guided radiofrequency ablation of osteoid osteoma is in comparison to surgery less invasive, time saving and economic technique with excellent long term results.

Arthroscopically treated intraarticular osteoid osteoma in the ankle--a report of 3 cases

We present 3 cases of arthroscopically treated intraarticular osteoid osteoma of the ankle. Emphasis is on the high index of suspicion for this lesion, the appropriate imaging modality and the efficacy of arthroscopic excision of these tumors with superficial location in the talus and tibial plafond.

Percutaneous ablation: safe, effective treatment of bone tumors

Percutaneous radiofrequency ablation (RFA) of osteoid osteomas has replaced surgical excision as the preferred method for treatment of these benign lesions, due to high effectiveness and low morbidity. Both RFA and cryoablation are safe and effective for palliation of pain due to metastatic disease in patients who have failed conventional therapies. These image-guided treatments can be performed precisely, allowing safe treatment of complex metastatic tumors. A single ablation treatment is effective in most patients, is well tolerated, and provides a long duration of pain relief

Imaging features of spinal osteoid osteoma with emphasis on MRI findings

A retrospective evaluation of the imaging of 13 patients with a diagnosis of osteoid osteoma (OO) of the spine was undertaken. Available imaging included radiographs (n=10), computed tomography (CT) (n=13), bone scintigraphy (n=5) and magnetic resonance imaging (MRI) (n=13). MRI features evaluated were pattern of neural arch and vertebral body oedema and the presence of an identifiable nidus. MRI features were correlated with other available imaging. There were seven males and six females with an age range of 8-59 years. On radiographs, scoliosis was present in ten and a sclerotic pedicle in nine patients. Focal increased uptake on bone scintigraphy consistent with OO was seen in all five patients where scintigraphy was available. On CT, a nidus was identified in all patients and reactive sclerosis was seen in 12. MRI demonstrated the nidus in eight patients and unilateral neural arch oedema with anterior extension to involve the ipsilateral posterolateral vertebral body in 11. When MRI is performed in the evaluation of back pain, the presence of unilateral neural arch oedema extending to involve the posterolateral vertebral body raises the possibility of spinal OO and should prompt CT to confirm the presence of a nidus.

Diagnostic Efficacy of Thin Slice CT in Osteoid Osteoma of the Thoracic Spine

We present a 24-year-old man and a 31-year-old woman who complained of persistent back pain with osteoid osteoma of the thoracic spine. Computed tomography (CT) revealed a round sclerotic lesion in the posterior element of the thoracic spine, although their plain radiographs showed no abnormalities except a slight scoliosis. The patients underwent total excision of the tumor via a posterior approach. They are currently asymptomatic with no recurrence of the lesion and have returned to full activity. The thin slice CT is one of the most important diagnostic tools for osteoid osteoma of the spine.

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%).

LEVEL OF EVIDENCE

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.

Glomus tumor of the thigh: confluent with the periosteum of the femur

True glomus tumor is rare. In the majority of cases it involves the hand, preferring the fingertips or nail beds. We report a patient with glomus tumor of the mid-thigh who presented with severe localized pain and limp. The imaging features are discussed and the English literature reviewed.

Ostéome ostéoïde de l'os trapézoïde : à propos d'un cas et revue de la littérature

Osteoid osteomas are often localised in long bones but only rarely in the carpus. This is a case report of an osteoid osteoma in the trapezoid. Diagnosis was difficult and established late, due to misleading initial symptoms. Radiological examination allowed localisation of the nidus. For osteoid osteoma localised in a carpal bone, we recommend total removal without bone-graft or arthrodesis.

Osteoid osteoma of the spine: a novel technique using combined computer-assisted and gamma probe-guided high-speed intralesional drill excision

STUDY DESIGN

A report of five cases of thoracolumbar osteoid osteoma treated with combined computer-assisted and gamma probe-guided high-speed drill excision.

OBJECTIVES

To document the surgical technique consisting of a combination of both computer-assisted and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine.

SUMMARY OF BACKGROUND DATA

Curative treatment of spinal osteoid osteoma is performed by surgical intralesional excision of the nidus, but intraoperative localization of the nidus is often difficult. Although intraoperative gamma-probe guidance facilitates accurate localization of the nidus, wide surgical resection of the bony structure is still mandatory to ensure removal of the nidus. Computer-assisted surgery has been proven to facilitate surgical intervention in spinal surgery. However, there is no clinical report regarding the application and usefulness of computer-assisted intralesional excision of the osteoid nidus. Excision of the nidus with a computer-assisted high-speed drill and intraoperative gamma probe control may result in complete intralesional excision without sacrificing more bone than necessary.

METHODS

One day before surgery, patients were injected with radioactive mTc-oxidronate. With a computed tomography-based electro-optical navigation system, real-time virtual images of the osteoid osteoma were generated by matching the intraoperative surface with preoperative computed tomography images. The osteoid osteoma was excised with the use of an image-guided high-speed drill, and complete excision was controlled with a gamma detection probe.

RESULTS

Excision of the nidus was confirmed by relief of symptoms, postexcision computed tomography scans, and histologic evaluation on clinical and radiographic follow-up observation. All five patients reported immediate complete relief of characteristic pain and no evidence of recurrence after 6 to 33 months of follow-up observation. There were no complications.

CONCLUSIONS

The combination of both computer-assisted surgery and gamma probe-guided high-speed drill excision for osteoid osteoma of the spine helps to localize and excise the nidus of the osteoid osteoma with minimal bone resection of the posterior spinal structures.

Image-guided surgery in resection of benign cervicothoracic spinal tumors: a report of two cases

BACKGROUND CONTEXT

Osseous spinal tumors are an uncommon cause of persistent axial pain and muscle spasm, but even benign lesions may grow to cause deformity or neurological signs. Traditional treatment approaches to resection can be debilitating even when the tumor is benign.

PURPOSE

Emerging technologies allow surgeons to diagnose and treat osseous neoplasms while minimizing the collateral damage caused by surgical exposure and tumor excision.

STUDY DESIGN

Technical considerations are presented through two cases of benign osseous neoplasm occurring in the cervicothoracic spine of competitive athletes, demonstrating the meth-ods used to provide effective treatment while maintaining maximal functional capacity.

METHODS

Stereotactic imaging and intraoperative guidance was used as an adjunct to tumor care in these patients. Used in combination with minimally invasive, microsurgical techniques,stereotactic guidance localized and verified excision margins of benign vertebral lesions, minimizing soft tissue trauma and collateral damage.

RESULTS

Computer-assisted stereotactic localization allowed us to successfully ablate these lesions from their anatomically challenging locations, without disrupting the shoulder girdle or neck musculature, and without extensive bony resection.

CONCLUSIONS

Image guidance can accurately localize and guide excision of benign vertebral lesions while minimizing soft tissue trauma and collateral damage, allowing patients a rapid and complete return to high-demand function.

Das Osteoidosteom im Bereich der Hand und des Handgelenks

PURPOSE

Osteoid osteoma is a painful benign bone tumour and very rare in the hand and wrist. Diagnosis may be very difficult and often is made after multiple previous diagnostic errors.

METHODS AND PATIENTS

From 1992 until 2003, 22 patients (11 men, 11 women) were operated on because of an osteoid osteoma of the hand or wrist in our hospital. The mean age was 30 years, ranging from 14 to 62 years. We retrospectively analysed patient records. A clinical examination with X-ray control was performed in 14 patients. Five patients were questioned by phone; three patients were lost to follow-up.

RESULTS

The mean time interval between onset of symptoms and surgical removal of the tumour was approximately two years. Symptoms were often non-specific; clinical findings varied according to localisation of the tumour. Conventional X-rays did not always show typical pathological findings. Bone scanning and gadolinium-enhanced MRI proved to be very sensitive in detecting the pathological process. High-resolution CT-scan demonstrated the nidus exactly. Usually, operative removal of the nidus resulted in immediate pain relief. At follow-up, 18 patients were free of pain. However seven patients had had a revision operation; in four of those, osteoid osteoma recurred once again.

CONCLUSIONS

In our opinion, it is important to consider osteoid osteoma as a possible cause of otherwise unexplained pain of the hand or wrist. If there is clinical suspicion, we recommend the early use of gadolinium-enhanced MRI as a sensitive screening method. Thus, it should be possible to shorten the time interval until correct diagnosis is established.

Osteoid osteoma: factors for increased risk of unsuccessful thermal coagulation

PURPOSE

To retrospectively identify risk factors that may impede a favorable clinical outcome after thermocoagulation for osteoid osteoma.

MATERIALS AND METHODS

Informed consent (permission for the procedure and permission to use patient data for analysis) was obtained from all patients who met study criteria, and institutional review board did not require approval. Analysis included age, sex, size and location of osteoid osteoma, presence of calcified nidus, number of needle positions used for coagulation, coagulation time, accuracy of needle position, learning curve of radiologist, and previous treatment in 95 consecutive patients with osteoid osteoma treated with thermocoagulation. With chi(2) analysis, Fisher exact test, or unpaired Student t test and logistic regression analysis, 23 unsuccessfully treated patients were compared with 72 successfully (pain-free) treated patients.

RESULTS

Parameters associated with decreased risk for treatment failure were advanced age (mean age, 24 years in treatment success group vs 20 years in treatment failure group) and increased number of needle positions during thermocoagulation. Estimated odds ratios were, respectively, 0.93 (95% confidence interval: 0.88, 0.99) and 0.10 (95% confidence interval: 0.02, 0.41). Patients with a lesion of 10 mm or larger seemed at risk for treatment failure (odds ratio = 2.68), but the 95% confidence interval of 0.84 to 8.52 included the 1.00 value. Needle position was inaccurate in nine of 23 patients with treatment failure; only one needle position was used in eight of these nine patients. Lesion location, calcification, sex, coagulation time, radiologist's learning curve, and previous treatment were not risk factors.

CONCLUSION

Multiple needle positions reduce the risk of treatment failure in all patients and should especially, but not exclusively, be used in large (> or =10-mm) lesions or lesions that are difficult to engage to reduce the risk for unsuccessful treatment.

MRI in diagnosis of osteoid osteoma of the proximal femur: a potentially deviating aspect. Description of a clinical case

Osteoid osteoma constitutes 10-12% of all benign neoplasms of the bone. The tumor more frequently involves the male sex (male to female ratio 2.1:1) and it may be observed in all age groups, with evident predilection for the second decade of life. All of the skeletal segments may be affected, but the most frequent site is the long bones, in the diaphyseal, metaphyseal and more rarely epiphyseal regions. The lesion is characterized by an osteolytic area, the nidus, which is at times partially calcified, surrounded by an osteosclerotic zone that is more or less accentuated. Clinical suspicion and traditional radiography are essential in diagnostic orientation; usually, further imaging methods are also recommended, such as bone scan with Tc99, CT scan and MRI. This last method allows for easy localization of the lesion, although with a sensitivity that is less than that of the CT scan. Nonetheless, the finding, if not supported by clinical suspicion, may be dangerously deviating and it may orient diagnosis towards a more aggressive disease.

Osteoid osteoma: painful enlargement of the second toe

Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of an osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision. Although soft-tissue swelling with a typical clinical history is suggestive of the diagnosis, differentiation from subacute infection is subtle and may ultimately depend on tissue analysis.

Gamma probe localization of cranial bone lesions: technical note

BACKGROUND

Intraoperative localization of cranial bone lesions may be challenging especially when the lesion is not well demonstrated on computed tomography (CT) scan but solely on a radio-isotope bone scan. We hereby demonstrate a technique for localizing such lesions using an intraoperative gamma probe reader and summarize the relevant literature.

METHODS

A case report of a temporal osteoid osteoma causing local pain and unresponsive to conservative treatment is presented. The lesion was demonstrated preoperatively solely on a bone scan, and was intra-operatively localized by a gamma probe reader.

RESULTS

The lesion was totally excised with normal background readings after lesion removal. Six months after total removal of the osteoid osteoma, the patient is asymptomatic.

CONCLUSION

Intraoperative gamma probe reader is a simple, effective, and safe method for intra-operative localization of bone lesions, which are positive on bone scans. It is especially useful for skull lesions that are not demonstrated by other imaging methods.

Intraarticular osteoid osteoma: clinical features, imaging results, and comparison with extraarticular localization

OBJECTIVE

Intraarticular osteoid osteoma is uncommon and presents diagnostic difficulties, which are important for both rheumatologists and orthopedic surgeons. Clinical symptoms, imaging procedures, differential diagnostic problems, and treatment results of intraarticular as compared with extraarticular osteoma are analyzed in this retrospective study.

METHODS

Nineteen patients with intraarticular osteoid osteomas (Group A), with a mean followup period of 34 months, are compared with 15 others with extraarticular lesions (Group B).

RESULTS

Nine intraarticular tumors were located in the hip, 3 in the elbow, 6 in the ankle, and one in the first metatarsal head. The nonspecific symptoms in Group A, such as chronic synovitis, decreased range of motion, joint effusion, contractures, and lack of the intense perifocal sclerotic margin on radiographs, led to significant delay in diagnosis (on average 26.6 mo in Group A, 8.5 mo in Group B). The extreme variety of previous diagnoses at referral reflect the problems of differential diagnosis. A detectable nidus is often absent on conventional radiograph. Bone scintigraphy is unspecific and often fails to visualize the nidus. Computed tomography scans were accurate in two-thirds of the intraarticular and in 90% of extraarticular cases. Magnetic resonance image findings, although sometimes controversial, provided essential additional information for the correct diagnosis and therapy.

CONCLUSION

Clinical symptoms and imaging signs of intraarticular osteoid osteomas were significantly different from the classical hallmarks of extraarticular lesions. The 10% intraarticular occurrence of osteoid osteomas in this series is not as rare as some investigators suggest. The radiological and clinical findings are uncharacteristic and misleading, and the lesions are difficult to identify. Careful search for history data, such as nocturnal pain and positive salicylate test, in addition to extensive imaging procedures, led to the correct diagnosis prior to surgery in two-thirds of our patients with intraarticular osteoid osteomas.

Arthroscopic removal of the osteoid osteoma on the neck of the talus

Juxta-articular osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus will commonly produce symptoms mimicking monoarticular arthritis or trauma. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. We present an arthroscopic removal of an osteoid osteoma on the neck of talus, and review the literature.

[Osteoid osteoma--ten-years' experience in therapy]

AIM

To review ten-years experience in diagnostics and operative treatment of osteoid osteoma.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Minimally invasive surgery for ablation of osteoid osteoma of the spine

STUDY DESIGN

Compare the effectiveness of two different techniques for the management of osteoid osteoma of the spine.

OBJECTIVE

To describe the technique, feasibility, and indications of two different minimally invasive surgical methods for the treatment of osteoid osteoma of the spine.

SUMMARY OF THE BACKGROUND DATA

Current treatment of osteoid osteoma of the spine is usually conventional surgical excision. The successful treatment of osteoid osteoma of the appendicular skeleton by percutaneous radiofrequency probe ablation is known; however, there have been only a few cases reported utilizing this method to treat osteoid osteoma of the spine. The high success rate of percutaneous transpedicle vertebral biopsy and diskectomy led us to believe this technique can also be applicable for the treatment of osteoid osteoma of the spine.

METHODS

Two patients with symptomatic osteoid osteoma of the spine underwent two different surgical managements with local anesthesia. In one patient, the osteoid osteoma was localized in the apex of the right L4 superior articular process joint. Under computed tomography guidance he underwent radiofrequency coagulation with the use of a radiofrequency generator at 90 degrees for 240 seconds. The lesion in the second patient was located in the right pedicle of the T9 vertebra close to the exiting nerve root and was cored out by means of a special percutaneous instrument designed for percutaneous biopsy under fluoroscopic guidance.

RESULTS

Both patients experienced immediate relief of pain, resumed their regular activities, and also remained free of symptoms after the 2.5- and 3-year follow-up.

CONCLUSION

Minimally invasive surgery can successfully be applied in the treatment of osteoid osteoma of the lumbar spine. When the nidus is not adjacent to the neural elements radiofrequency thermal ablation can be an effective and safe treatment of osteoid osteoma in the spine.

Osteoid osteomas and osteoblastomas of the spine

OBJECT

Osteoid osteomas and osteoblastomas are rare primary bone tumors that usually do not arise in the spine. In this report the authors analyze 16 cases of osteoid osteoma or osteoblastoma of the spine that were surgically treated over a 27-year period.

METHODS

A retrospective study was conducted in which the following data were found: five patients had osteoid osteomas (two male and three female patients) and 11 had osteoblastomas (seven male and four female patients). The site of the tumor was the cervical spine in four, thoracic in six, and lumbar spine in six. In 14 patients, the tumor involved the posterior vertebral elements, with lumbar and thoracic levels being the most common. Only two patients had tumors in the body of a cervical vertebra. The mean age of the patients was 20 years for osteoid osteoma and 19 years for osteoblastoma. The most common symptom was local pain in the area of the tumor. Among 11 patients with osteoblastoma, six (two with paraparesis, four with monoparesis) had neurological deficits caused by extradural compression. None of the patients with osteoid osteoma had neurological deficits. The diameters of osteoblastomas were 3 to 8 cm (mean 4 cm), and those of osteoid osteomas were 1.5 to 2 cm (mean 1.7 cm). Although the peritumoral bone was normal in patients with osteoblastoma, a sclerotic rim was observed in all patients with osteoid osteoma. All patients were treated with resection; tumor excision was complete in 15 cases. Follow-up periods ranged from 2 months to 13 years (mean 36 months). Complete pain relief was achieved in 15 patients; the other patient described mild pain with activity. There was no tumor recurrence except one regrowth in a patient with osteoblastoma who then received radiation therapy. There were two complications: one surgery was performed at the wrong level, and there was one instrument failure that required revision.

CONCLUSIONS

With the help of modern imaging modalities that aid in diagnosis and surgical planning, a complete removal and cure may be achieved for most of these rare tumors.

Percutaneous destruction and alcoholisation for the management of osteoid osteoma

Osteoid osteoma (OO) is a small, self-limiting, benign osteogenic tumour. Successful treatment of OO requires complete resection or destruction of the nidus. Surgery, which consists of en bloc excision of the nidus, followed by internal fixation, bone grafting, or both, is successful in almost all cases. In a small percentage of cases the nidus may be missed at surgery, resulting in a failed procedure. The aim of this study was to evaluate the results of percutaneous destruction and alcoholisation as a treatment of OO. Fifteen patients with an osteoid osteoma (10 males, 5 females) were treated in the Oncology Unit, Orthopaedic Department, Mansoura University Hospital. Three OOs were localised in the humerus, 5 in the femur, 6 in the tibia and fibula, and one in the talus. All patients underwent destruction of the nidus by determining the nidus by CT, drilling with a cannulated drill bit, curretting with a speed burr and injecting ethanol. The nidus completely disappeared on the postoperative CT-scan. The average follow-up period was 19 months (6-24 months). There were no postoperative complications. This technique for the treatment of OO is minimally invasive, safe, simple, and cost effective. It allows an early return to normal activities. The procedure is particularly useful for a lesion located deep in the skeleton, which would require an extensive approach with conventional surgery.

MR imaging-guided laser ablation of osteoid osteomas with use of optical instrument guidance at 0.23 T

The purpose of this study was to determine the feasibility and features of low-field MR imaging in performing interstitial laser ablation of osteoid osteomas. Between September 2001 and April 2002, five consecutive patients with clinical and imaging findings suggesting osteoid osteoma and referred for removal of osteoid osteoma were treated with interstitial laser treatment. A low-field open-configuration MRI scanner (0.23 T, Outlook Proview, Philips Medical Systems, Finland) with optical instrument guidance hardware and software was used. Laser device used was of ND-Yag type (Fibertom medilas, Dornier Medizin Technik, Germany). A bare laser fiber (Dornier Medizin Technik, Germany) with a diameter of 400 microm was used. Completely balanced steady-state (CBASS; true fast imaging with steady precession) imaging was used for lesion localization, instrument guidance, and thermal monitoring. A 14-G (Cook Medical, USA) bone biopsy drill was used for initial approach. Laser treatment was conducted through the biopsy canal. All the lesions were successfully localized, targeted, and treated under MRI guidance. All the patients were symptom free 3 weeks and 3 months after the treatment. There was one recurrence reported during follow-up (6 months). The MRI-guided percutaneous interstitial laser ablation of osteoid osteomas seems to be a feasible treatment mode.

Basic and clinical studies of percutaneous radiofrequency ablation of osteoid osteoma using a standard electrosurgical generator

For percutaneous radiofrequency ablation of osteoid osteoma for pain management, we used a standard electrosurgical generator instead of the radiofrequency generator system. First, we used the standard electrosurgical generator to determine the diameter of the coagulated area of normal femurs and humeruses of dogs under general anesthesia and to detect damage to normal tissue around the bone. We then used a standard electrosurgical generator to perform percutaneous radiofrequency ablation of the osteoid osteoma. All three patients were almost pain-free within the first 24 h after the procedure, and they were discharged the day after the operation, being hospitalized for only 2 days. We thus confirmed that percutaneous radiofrequency ablation using a standard electrosurgical generator produced results similar to those achieved with the radiofrequency generator system.

Intracranial mesenchymal chondrosarcoma with osteoid formation: report of a pediatric case

CASE REPORT

We present a case of a 14-year-old girl with a 3-week history of severe progressive headache and intermittent vomiting. Magnetic resonance imaging (MRI) revealed a large intensely enhancing mass, which seemed to arise from the right side of the cerebral fossa with implant base in the inferior face of the tentorium and significant mass effect on the nearby structures. A presumptive preoperative diagnosis of meningioma was made. Subtotal surgical resection was performed using the occipital approach. Histologically the neoplasms had the classic features of a mesenchymal chondrosarcoma associated with the focal presence of osteoid matrix.

DISCUSSION

Clinical features, therapeutic approaches and prognosis of this rare tumour are discussed with regard to the known 30 cases in the literature.

Osteoid osteoma of the glenoid: minimally invasive treatment

Osteoid osteoma is a benign neoplasm that is often associated with a delay in diagnosis and severe pain. When indicated, surgical extirpation can be quite difficult, depending on the anatomic site of the tumor. Recent advances in radiofrequency ablation have dramatically impacted the successful treatment of these lesions. In this paper, a case report with review of the literature is presented to update all orthopedic surgeons on the use of this technique-especially important since it may obviate the need for surgery for many patients.

Benign sacral tumors

Primary tumors of the sacrum are rare. In adults, the most common sacral tumors are metastases. The most common primary sacral tumor is a chordoma. Chordomas along as well as tumors such as chondrosarcomas, osteosarcomas, myxopapillary ependymomas, myelomas, and Ewing sarcomas are considered malignant. In this article the authors focus on benign sacral tumors.