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Preoperative Ultrasound-guided Wire Localization of Soft Tissue Masses Within the Musculoskeletal System. Ultrasound Q 2020; 36:357-362. [PMID: 33298773 DOI: 10.1097/ruq.0000000000000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasound-guided hookwire localization was initially introduced to facilitate the excision of nonpalpable breast lesions by guiding surgical exploration, thereby reducing operative time and morbidity. The same technique has since found utility in a range of other applications outside breast and can be useful within the musculoskeletal system. Despite this, there remains limited literature with respect to its technical aspects and practical utility. We describe our technique and a series of preoperative ultrasound-guided wire localizations in the musculoskeletal system to assist surgical excision of 4 soft tissue masses.
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Thomas C, Müller-Bierl BM, Rempp H, Siegmann K, Martirosian P, Claussen CD, Pereira PL. In vitro Assessment of Artifacts from Commercially Available Markers for Image-guided Preoperative Marking of Bone and Soft Tissue Lesions. J Vasc Interv Radiol 2010; 21:1100-4. [DOI: 10.1016/j.jvir.2010.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 02/28/2010] [Accepted: 04/03/2010] [Indexed: 10/19/2022] Open
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Pratali R, Zuiani G, Inada M, Hanasilo C, Reganin L, Etchebehere E, Etchebehere M. Open resection of osteoid osteoma guided by a gamma-probe. INTERNATIONAL ORTHOPAEDICS 2009; 33:219-23. [PMID: 18478229 PMCID: PMC2899246 DOI: 10.1007/s00264-008-0552-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 02/23/2008] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
Abstract
Osteoid osteoma is the third most common type of bone tumour. Radiofrequency ablation and other percutaneous procedures are the treatment of choice. However, in some sites these methods are difficult or dangerous. Our objective of this study was to evaluate whether open resection and intraoperative nidus detection with a hand-held gamma probe is an efficient method for treating this type of tumour. Fifty-three patients with osteoid osteomas were submitted to surgical treatment. The first group (gamma group) consisted of 34 patients submitted to open nidus resection guided by a hand-held gamma probe. The control group consisted of 19 patients operated on by conventional technique. In the postoperative period, histopathology, imaging studies, and clinical outcome were evaluated. The gamma group patients were followed up for an average 26.2 months; the control group patients were followed up for an average 38 months. There was no difference with regard to pain relief and histopathology findings between the two groups. However, in the postoperative imaging studies, there was significantly less nidus present in the gamma group (p = 0.01).The gamma probe helped to locate the osteoid osteoma nidus more precisely, as demonstrated by the postoperative imaging studies.
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Affiliation(s)
- Raphael Pratali
- Ortopedia e Traumatologia, FCM UNICAMP, Tessalia Vieira de Camargo, 126. Cidade Universitária, Campinas, 13081-970, Brazil.
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Gottfried ON, Dailey AT, Schmidt MH. Adjunct and Minimally Invasive Techniques for the Diagnosis and Treatment of Vertebral Tumors. Neurosurg Clin N Am 2008; 19:125-38. [DOI: 10.1016/j.nec.2007.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Eng Hin Lee
- Department of Orthopaedic Surgery, National University of Singapore, Singapore.
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Franceschi F, Marinozzi A, Rizzello G, Papalia R, Rojas M, Denaro V. Computed tomography-guided and arthroscopically controlled en bloc retrograde resection of a juxta-articular osteoid osteoma of the tibial plateau. Arthroscopy 2005; 21:351-9. [PMID: 15756191 DOI: 10.1016/j.arthro.2004.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteoid osteoma represents approximately 10% to 11% of all the benign bone tumors. The localization at the articular and juxta-articular level of the knee is an atypical picture that causes both diagnostic and therapeutic problems. We present the case of an osteoid osteoma of the lateral tibial plateau just beneath the joint level. The lesion was removed by a rear-entry computed tomography (CT)-guided drill under arthroscopic control and the bony defect filled with bone graft harvested from the proximal tibial metaphysis. Postoperative CT scans at 3 months, and 1 and 2 years were performed. The result of the kneeling test to evaluate donor-site morbidity 1 year after the surgery was negative. There were no immediate or delayed complications. Currently (2 years postoperatively), the patient has no pain and has gone back to his normal active daily lifestyle and routines. The follow-up CT scan 2 years after surgery showed complete excision of the lesion and perfect positioning of the bone graft. This new approach/technique enabled us to avoid damaging the proximal structures, to examine the lesion, and to fill the bony defect. Moreover, as shown by CT scan at follow-up, iatrogenic lesions to the cartilage of the tibial plateau were not reported.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedics and Traumatology, School of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy.
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Etchebehere M, Etchebehere ECSC, Reganin LA, Amstalden EMI, Cliquet A, Camargo EE. Intraoperative localization of an osteoid-osteoma using a gamma probe. INTERNATIONAL ORTHOPAEDICS 2004; 28:379-83. [PMID: 15538565 PMCID: PMC3456907 DOI: 10.1007/s00264-004-0588-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2004] [Accepted: 07/13/2004] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate whether intraoperative nidus detection with a hand-held gamma probe was efficient enough for use as a routine procedure. Thirty-seven patients with osteoid-osteomas were submitted to surgical treatment. The first group consisted of 19 patients submitted to open nidus resection using a hand-held gamma probe as guide. The control group consisted of 18 patients operated on by conventional technique. The procedures were classified as successful if nidus resection could be confirmed by histology or postoperative imaging studies. Patients in the gamma group were followed for a mean of 13 months; patients in the control group for a mean of 39 months. In the gamma group, 17/19 procedures were successful; in the control group, only 12/18 procedures were successful. The gamma probe helped to locate the osteoid-osteoma nidus, and the same probe could be used in various hospitals.
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Affiliation(s)
- M Etchebehere
- Department of Orthopedics and Traumatology, School of Medical Sciences, Campinas State University (UNICAMP), Av. Vital Brasil, 251-Cidade Universitaria Zeferino Vaz, Campinas, CEP 13083-970, SP, Brazil.
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Pereira PL, Fritz J, Koenig CW, Maurer F, Boehm P, Badke A, Mueller-Schimpfle M, Bitzer M, Claussen CD. Preoperative marking of musculoskeletal tumors guided by magnetic resonance imaging. J Bone Joint Surg Am 2004; 86:1761-7. [PMID: 15292425 DOI: 10.2106/00004623-200408000-00021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate a new stereotactic method for preoperative coil-marking of musculoskeletal tumors with use of interventional magnetic resonance imaging. METHODS Nine patients with a soft-tissue or bone-marrow tumor were referred to our department for preoperative marking of the extent of the lesion. In one patient, two lesions were marked. Guidance for the punctures and the delivery of the coils was provided by an open low-field magnetic resonance imaging system with horizontal access. After imaging of the extent of the lesion, magnetic resonance imaging-compatible titanium coils were placed with use of nearly real-time or step-by-step magnetic resonance imaging control. The coils were placed up to seventy-two hours before the surgery. The inclusion of the tumor borders within the area of the excision was examined with cross-sectional histological analysis of surgical specimens. RESULTS The tumor-marking intervention was successfully performed with the guidance of magnetic resonance imaging only in all patients. Preoperatively, nineteen coils were used to mark the ten lesions in the nine patients. All of the coils were easily located with intraoperative fluoroscopy. No coil migrated between the time of the percutaneous marking and the surgery. Histological examination of the resection borders revealed no residual tumor cells. No complications were observed, and, after a mean of twenty-three months of follow-up, no tumor had recurred. CONCLUSIONS Preoperative coil-marking guided by magnetic resonance imaging for exact delineation of a musculoskeletal tumor is technically feasible and can readily demonstrate the full extent of the tumor. Use of magnetic resonance fluoroscopy reduces the time needed for the intervention. We recommend the coil-marking technique.
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Affiliation(s)
- Philippe L Pereira
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany.
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Athwal GS, Pichora DR, Ellis RE, Rudan JF. A computer-assisted guidance technique for the localization and excision of osteoid osteoma. Orthopedics 2004; 27:195-7. [PMID: 14992386 DOI: 10.3928/0147-7447-20040201-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- George S Athwal
- Division of Orthopedic Surgery, Department of Surgery, Queen's University, Kingston General Hospital, Ontario, Canada
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Cantwell CP, Obyrne J, Eustace S. Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation. Eur Radiol 2003; 14:607-17. [PMID: 14663625 DOI: 10.1007/s00330-003-2171-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Revised: 06/19/2003] [Accepted: 11/03/2003] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Colin P Cantwell
- Department of Radiology, The Mater Misericordiae and Cappagh National Orthopaedic Hospital, Eccles Street, Dublin, Ireland.
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Abstract
Diagnosis of osteoid osteoma often is delayed, despite its high incidence, because of similarities in presenting symptoms with other pathologic entities. The current case report describes a posttraumatic osteoid osteoma. Three years after osteosynthesis of a distal tibial fracture an osteoid osteoma was diagnosed at the former fracture site. After excluding osteomyelitis as a possible diagnosis, the tumor was excised successfully. Based on current knowledge of the pathogenesis of osteoid osteoma, it is unlikely that the lesion observed in the patient was attributable to the previous fracture.
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Affiliation(s)
- W Schulze
- Department of Surgery, Berufsgenossenschaftlichen Kliniken Bergmannsheil Bochum, Germany
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Morrison WB, Sanders TG, Parsons TW, Penrod BJ. Preoperative CT-Guided Hookwire Needle Localization of Musculoskeletal Lesions. AJR Am J Roentgenol 2001; 176:1531-3. [PMID: 11373227 DOI: 10.2214/ajr.176.6.1761531] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- W B Morrison
- Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., Philadelphia, PA 19107, USA
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Tie ML, Rao MM, Russell C, Burapa K. Transperitoneal guide-wire or drainage catheter placement for guidance of laparoscopic marsupialization of lymphocoeles post renal transplantation. Nephrol Dial Transplant 2001; 16:1038-41. [PMID: 11328913 DOI: 10.1093/ndt/16.5.1038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lymphocoeles post renal transplantation can be difficult to see laparoscopically. The objective of this study was to report a new technique of catheter or guide-wire placement for the guidance of laparoscopic marsupialization of symptomatic post renal transplant lymphocoeles, refractory to conservative therapy. METHODS Conventional aseptic technique under local anaesthesia was used for guide-wire or catheter insertion, with the difference being the use of a transperitoneal approach. Computerized tomography (CT) or ultrasound (US) guidance was used. All lesions were confirmed to be sterile lymphocoeles beforehand by either needle aspiration or previous catheter drainage. RESULTS Four catheters and one guide-wire were placed pre-operatively without complication. All cases underwent satisfactory laparoscopic marsupialization. No immediate complications were noted in any patient. The drainage catheters were inserted between 5 and 19 days before laparoscopic marsupialization, and guide-wire inserted immediately before. All patients proceeded to laparoscopic marsupialization. CONCLUSIONS This technique offers precise guidance on laparoscopic surgery, is relatively simple to perform and no complications were experienced in this study. Its use is limited to sterile and benign lesions due to the risks of peritoneal seeding, making recurrent post-operative lymphocoeles ideally suited for this application.
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Affiliation(s)
- M L Tie
- Department of Radiology, North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, Woodville, Adelaide, South Australia 5011, Australia
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Mastrokalos DS, Pässler HH, Tibesku CO, Wrazidlo W. Computed tomography-guided endoscopic removal of an osteoid osteoma from the femur. Arthroscopy 2001; 17:62-6. [PMID: 11154369 DOI: 10.1053/jars.2001.8023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The case of a 19-year-old male patient who complained of dull pain in his right knee for more than 18 months and was finally diagnosed with intracortical osteoid osteoma in the femoral diaphysis is presented. A new operative method was used to locate and remove the tumor. Under spinal anesthesia with the patient in the prone position, a lateral and a posterior approach were marked with special bone cutting tubes under computed tomographic control. The usual arthroscopic instruments (punch, retrograde suction stamp) were used to remove the nidus under arthroscopic visualization, thereby avoiding the disadvantages of open excisions, such as large incisions, bone loss, long hospitalization, and risk of infection. The advantages and disadvantages are thoroughly discussed and compared with conventional surgical procedures.
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Affiliation(s)
- D S Mastrokalos
- Center for Knee and Foot Surgery, Department of Radiology, ATOS Clinic, Heidelberg, Germany
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Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Decreasing length of hospital stay in treatment of osteoid osteoma. Clin Orthop Relat Res 1999:186-91. [PMID: 10212612 DOI: 10.1097/00003086-199904000-00024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ninety-eight operative procedures were performed for treatment of osteoid osteoma since 1978 at the authors' institution. During these years there was a progressive decrease in the length of hospital stay, decreasing from a mean of 6.8 days between 1978 and 1980 to 2.6 days between 1994 and 1996. Factors that influenced the length of stay after a surgical procedure include patient age, lesion location, choice of procedure, and surgeon. However, the decline in length of stay with time is independent of these factors, and antedates the era of managed care. Increased reliance on more conservative surgical procedures has markedly diminished the length of hospital stay required in the care of these patients.
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Affiliation(s)
- D I Rosenthal
- Department of Radiology, Massachusetts General Hospital, Boston 02114, USA
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Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am 1998; 80:815-21. [PMID: 9655099 DOI: 10.2106/00004623-199806000-00005] [Citation(s) in RCA: 376] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Osteoid osteoma, a benign bone tumor, has traditionally been treated with operative excision. A recently developed method for percutaneous ablation of the tumor has been proposed as an alternative to operative treatment. The relative outcomes of the two approaches to treatment have not previously been compared, to our knowledge. The rates of recurrence and of persistent symptoms were compared in a consecutive series of eighty-seven patients who were managed with operative excision and thirty-eight patients who were managed with percutaneous ablation with radiofrequency. Patients who had a spinal lesion were excluded. The minimum duration of follow-up was two years. There was a recurrence, defined as the need for subsequent intervention, after operative treatment in six (9 per cent) of sixty-eight patients who had been managed for a primary lesion and in two of nineteen who had been managed for a recurrent lesion. The average length of the hospital stay was 4.7 days for the patients who had a primary lesion and 5.1 days for those who had a recurrent lesion. There was a recurrence after percutaneous treatment in four (12 per cent) of thirty-three patients who had been managed for a primary lesion and in none of five who had been managed for a recurrent lesion. The average length of the hospital stay was 0.2 day for these thirty-eight patients. With the numbers available, we could detect no significant difference between the two treatments with regard to the rate of recurrence. The rate of persistent symptoms (that is, symptoms that did not necessitate additional treatment) was greater than the rate of recurrence. According to responses to a questionnaire, eight (30 per cent) of twenty-seven patients had persistent symptoms after operative treatment and six (23 per cent) of twenty-six patients had persistent symptoms after percutaneous treatment with radiofrequency. Two patients had complications after operative excision, necessitating a total of five additional operations. There were no complications associated with the percutaneous method. The results of the present study suggest that percutaneous ablation with radiofrequency is essentially equivalent to operative excision for the treatment of an osteoid osteoma in an extremity. The percutaneous method is preferred for the treatment of extraspinal osteoid osteoma because it generally does not necessitate hospitalization, it has not been associated with complications, and it is associated with a rapid convalescence.
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Affiliation(s)
- D I Rosenthal
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
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