Peripheral osteoid osteoma. Is there still a place for traditional surgery?

An Atypical Presentation of an Osteoid Osteoma of the Lesser Trochanter Resected via the Ludloff Approach

Osteoid osteoma is a benign bone tumor that frequently affects young adults. The clinical presentation is variable, and the course can lead to spontaneous regression or persistence, necessitating medical or surgical treatment. We report the case of a young patient with an exceptional localization of an osteoid osteoma at the lesser trochanter, exhibiting atypical clinical and radiological features. The tumor was resected via the Ludloff approach. Here, we discuss our diagnostic and therapeutic approach in light of the literature.

Osteoid Osteomas of the Talus: A Case Report of Four Patients

Osteoid osteomas are benign bone tumors that are commonly found in the cortical segments of long bone but can occasionally occur in the talus of the foot. They typically present in younger males and are characterized by lesions with a vascularized nidus surrounded by sclerotic bone. Plain radiographs can often miss the diagnosis, requiring further imaging with computed tomography (CT) or magnetic resonance imaging (MRI). Lesions often lead to a significant inflammatory response resulting in an impaired range of motion and nocturnal pain. Conservative management with non-steroidal anti-inflammatory medications and a walking boot is considered first-line therapy, with failure to respond being an indication for surgical intervention. Surgical treatment traditionally consisted of en bloc resection but has been replaced by CT-guided radio-frequency ablation (RFA) when conservative management has failed. Four cases of osteoid osteoma of the talus are presented which all went on to RFA after conservative management failed. The patients' non-specific symptomatology and unremarkable findings on plain radiographs led to further evaluation using MRI or CT, which aided in the diagnosis. Following imaging, RFA was performed which resulted in 100% relief of pain and symptoms in all four patients and a return to full activity without limitations. Osteoid osteomas of the talus present unique challenges due to the non-specific symptoms and complex surrounding anatomy that accompanies this condition. Management should include the use of CT for localization and RFA of the lesion, which we have shown leads to complete resolution of symptoms and return to normal daily activities.

Comparison of arthroscopy versus percutaneous radiofrequency thermal ablation for the management of intra- and juxta-articular elbow osteoid osteoma: case series and a literature review

BACKGROUND

Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.

METHODS

The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.

RESULTS

Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.

CONCLUSIONS

Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint's reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow's range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.

Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option

Osteoid osteoma, the third most common benign bone tumor, usually occurs in the cortex of long bones. It consists of a radiolucent nidus surrounded by reactive osteosclerosis. Generally, osteoid osteoma affects young males. Nocturnal pain that eases with salicylates or nonsteroidal anti-inflammatory drugs (NSAID) is the typical clinical presentation. Sometimes, it remains undiagnosed for a long time. Plain radiography and computed tomography are usually sufficient for the diagnosis of osteoid osteoma. Initial treatment includes salicylates and NSAID because the tumor often regresses spontaneously over 2-6 years. Surgical treatment is indicated in case of unresponsive pain to medical therapy, no tolerance of prolonged NSAID therapy due to side effects, and no willingness to activity limitations. Nowadays, minimally invasive techniques have replaced open surgery and are considered the gold standard of surgical treatment. Although cryoablation seems superior in terms of the nerve damage and immunotherapy effect, radiofrequency ablation is the preferred technique.

Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma

Objectives

This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable.

Patients and methods

A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS).

Results

The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations.

Conclusion

Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.

Resection of Bone Tumor Guided by Gamma Probe and Evaluation of Postoperative Pain

Osteoid osteoma is a benign neoplasm commonly found in young men, but that can be found in every age, which affects mainly long bones, clinically characterized by continuous and limiting pain that is relieved by salicylates. It is a small lesion composed of immature osteoid tissue, central hypervascularization and surrounding sclerotic area. Its diagnosis is performed by the clinic and aided by imaging tests, such as common radiography and computed tomography. Radiography shows a central radiolucent lesion and peripheral sclerosis. The biopsy takes place only in cases of diagnostic doubt. Surgical treatment involves resection of the niche, providing greater symptomatic relief, as well as percutaneous techniques. The technique of radioisotope-guided resection has good acceptance in the scientific community for its fast surgical procedure directed to the lesion; however, the percutaneous technique that stands out is radiofrequency ablation. In the present study, all of the patients submitted to the technique presented total improvement of the pain.

Osteoid osteoma of the hip: imaging features

Osteoid osteoma (OO), a small bone tumor relatively common in young subjects, frequently involves the hip. In addition to typical findings, we emphasize unsuspected clinical and imaging features including painless OO causing limping gait, non-visibility of totally mineralized nidus, absence of hyperostosis or adjacent edema, and recurrence at distance from the initial location. We also discuss the option of medical treatment for some cases of deep hip locations.

Osteoid Osteoma in Children Younger than 3 Years of Age

We present a case series of four children, younger than 3 years old, with osteoid osteoma of the lower limb. Pain and limping were the main symptoms. With careful clinical examination, we could localize the affected area. Radiological evaluation revealed cortical thickening in 3 children. On MRI examination, we found extensive edema, with normal bony cortices. The central nidus was found in 3 children. CT scan was the most accurate examination which revealed the central nidus with surrounding sclerosis. Bone scans had positive uptake in the affected area. Our patients were treated with an intralesional excision biopsy, with simultaneous radiofrequency ablation in those affected in the femur. Pathological specimens confirmed the diagnosis of osteoid osteoma. There was uneventful recovery of our patients. This case series contributes to the limited description of osteoid osteoma diagnosed and treated in very young children.

Isolated primary bone tumours of the lesser trochanter: Demographics, diagnosis and management

Primary bone tumours arising from the lesser trochanter (LT) are rare and the literature describing them is sparse. In this paper, we describe the largest series of LT tumours describing the demographics, diagnosis and management.

METHODS

A retrospective search of prospectively maintained radiology and oncology databases was performed to identify bone tumours of the LT diagnosed between 2007 and 2018. Metastatic lesions were excluded. All cases were re-reviewed by a senior Radiologist and all case of isolated tumours of the LT were included.

RESULTS

23 cases of isolated LT tumours were identified. There were 15 males and 8 females. Mean age of our cohort was 32 (14-63) years. Most (n = 19, 82.6%) cases had classic radiological (Radiographic, MR Imaging and CT) features and therefore did not undergo biopsy. 4 patients had equivocal radiological investigations that required biopsy to confirm the diagnosis. MR imaging was the most commonly used imaging modality for diagnosis (n = 17, 73.9%)There was a broad range of tumour subtypes, and osteochondroma (n = 17, 73.9%) the most frequently diagnosed. Surgical excision was performed in 4 patients (all osteochondromas) and 4 patients underwent therapeutic radiological guided hip injections for symptomatic relief. The remaining cases were managed conservatively and where they were identified incidentally, no intervention was required.

CONCLUSION

We report the largest case series of isolated primary bone tumours of the LT. All isolated primary bone tumours of LT are benign. Osteochondroma is the most common. The diagnosis can be made with on radiological investigations in most patients.

[Diagnostics and treatment of osteoid osteoma]

BACKGROUND

Osteoid osteoma is the third most common benign bone tumor and typically induces pain that is worse at night.

OBJECTIVE

To identify the epidemiological, pathogenetic, histological and radiological characteristics of osteoid osteoma and to present the broad variety of treatment options.

MATERIAL AND METHODS

This review article summarizes relevant clinical studies and meta-analyses on this topic.

RESULTS

Osteoid osteoma is characterized by a central nidus smaller than 1.5 cm in diameter with surrounding bone sclerosis. In the majority of cases, the tumor occurs in the long bones of the lower extremities and is predominantly manifested in patients aged between 5 and 25 years. Pain is mediated by prostaglandins, which stimulate afferent peripheral nerve fibers. Besides plain radiographs, thin-section computed tomography represents the gold standard of diagnostics but should be complemented by magnetic resonance or nuclear medicine imaging modalities. The conservative treatment consists of long-term therapy with non-steroidal anti-inflammatory drugs. Minimally invasive radiofrequency ablation of the nidus is the current operative treatment of choice.

CONCLUSION

Success rates of radiofrequency ablation and other minimally invasive procedures are high while treatment costs and length of hospital stay are low. Thus, open surgical curettage is reserved for rare indications and en bloc excision of the nidus should only be performed in cases of recurrent lesions.

CT-guided radiofrequency ablation of osteoid osteoma using a multi-tined expandable electrode system

BACKGROUND AND AIM OF THE WORK

Radiofrequency ablation (RFA) is the gold standard for the treatment of symptomatic osteoid osteoma (OO) as RFA yields both a high success and low complication rate. It has been widely utilized over the years, but recurrences of OO after this treatment have been documented. These recurrences may be the result of various factors, including incomplete tumor ablation, and are significantly higher in lesions greater than 10 mm. Thus, the need to induce thermal ablation in a wider area led us to use a Multi-Tined Expandable Electrode System (MTEES). In this study we examined the efficacy and safety of RFA using a MTEES in symptomatic OO.

METHODS

Between January 2005 and June 2007, 16 patients with symptomatic OO were treated by CT-guided percutaneous RFA using a MTEES. The diameter of OO ranged from 6 to 15 mm (mean 10±2.6 mm). Patients were evaluated for clinical outcomes, complications and recurrence. Pain evaluation was assessed preoperatively, 2 weeks postoperatively and at last follow-up.

RESULTS

Clinical follow-up was available for all patients at a mean of 84.3 months (range 73-96 months). Mean preoperative VAS score was 7.4 (range 5-9), two weeks after the procedure mean VAS score was 0.3 (range 0-1) with a mean change of -7.06 points (p<0.0001). At the last follow-up a complete relief from pain has been observed in all patients. No major and minor complications were observed nor recurrences.

CONCLUSIONS

RFA using a MTEES has been effective, safe and reliable for the treatment of OOs. This system, by increasing the size of the necrosis, could be a viable alternative to the single needle electrode in lesions larger than 10 mm, reducing the risk of recurrence.

Arthroscopic Excision of an Osteoid Osteoma of the Lesser Trochanter of the Femoral Neck

Osteoid osteoma frequently requires surgical treatment, especially among young, active patients. However, surgeons are reluctant to perform open surgery for an osteoid osteoma of the femoral neck area because the conventional surgical approach requires a large incision in muscular patients, and percutaneous resection with a trephine has the attendant risk of subsequent fracture. Recently, arthroscopic excision of an osteoid osteoma has been reported as a less invasive, safer procedure than traditional open curettage. Hip arthroscopy using the burr-down technique under C-arm guidance to locate and remove the lesion of the femur neck has also shown promise. The presented technique minimizes muscle damage around the femur and enables surgeons to confirm complete resection of the lesion through direct, detailed visualization. Furthermore, early return to previous activity can be achieved after excising the lesion located at the calcar femorale, which is an area with a heavy weight-bearing load. The objective of this Technical Note was to describe our preferred technique for the surgical excision of osteoid osteoma located at the base of the femoral neck through the use of arthroscopy.

Arthroscopic Excision of an Intraarticular Osteoid Osteoma in the Distal Femur

An intraarticular osteoid osteoma of the knee is uncommon, and its treatment is challenging. The authors present a case of arthroscopic excision of an intraarticular osteoid osteoma in the distal femur, which was accessible through the knee joint. After confirming the nidus of the osteoid osteoma by computed tomography, the lesion was completely removed arthroscopically. The patient reported complete pain relief immediately after surgery. This case demonstrates that intraarticular osteoid osteomas in the knee joint can be treated by arthroscopic excision and that good results can be obtained.

Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note

PURPOSE

To report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling.

MATERIALS AND METHODS

During the last 18 months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported.

RESULTS

Access to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5 min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study.

CONCLUSIONS

The use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.

[Osteoidosteoma. From diagnosis to treatment]

An osteoid osteoma is a benign bone-forming tumor which usually presents in childhood and adolescence and is characterized by extensive nocturnal pain. Computed tomography (CT) is used to reveal the typical radiolucent nidus surrounded by a sclerotic reaction and in magnetic resonance imaging (MRI) a nidal enhancement and perifocal edema can confirm the diagnosis. Having shown excellent success rates radiofrequency ablation has become the treatment of choice which allows minimally invasive and precise destruction of nidal tumor tissue. By using thermal protection techniques and multiple ablation positions successful therapy of perineural tumors and niduses with diameters of more than 2 cm are possible.

An Alternative Surgical Method for Treatment of Osteoid Osteoma

BACKGROUND An osteoid osteoma is a benign bone tumor that tends to be <1 cm in size. The tumor is characterized by night-time pain that may be relieved by aspirin or other non-steroidal anti-inflammatory drugs. Osteoid osteoma can be treated with various conservative and surgical methods, but these have some risks and difficulties. The purpose of the present study was to present an alternative treatment method for osteoid osteoma and the results we obtained. MATERIAL AND METHODS In the period from 2010 to 2014, 10 patients with osteoid osteoma underwent nidus excision by using a safe alternative method in an operating room (OR) with no computed tomography (CT). The localization of the tumor was determined by use of a CT-guided Kirschner wire in the radiology unit, then, in the OR the surgical intervention was performed without removing the Kirschner wire. RESULTS Following the alternative intervention, all the patients were completely relieved of pain. In the follow-up, no recurrence or complication occurred. CONCLUSIONS The presented alternative method for treating osteoid osteoma is an efficient and practical procedure for surgeons working in clinics that lack specialized equipment.

A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma

PURPOSE

The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma.

MATERIALS AND METHODS

Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted.

RESULTS

The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups.

CONCLUSION

Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.

[Osteoid osteoma on distal phalanx tip of second toe, without scintigraphy fixation]

Osteoid osteoma is a very small painful, benign tumor, located preferentially on long bones. Cases on the phalanxes of the toes are very rare. Pain takes up nearly all the clinical presentation. Poor clinical signs and atypical location make diagnosis difficult and delayed. Sometimes, it can be confused with local infection. Various additional tests are described to help diagnosis. Technetium 99-m scintigraphy coupled with CT is the key exam with high sensitivity and morphological accuracy. We report on the case of a 10-year-old boy with an atypical location of osteoid osteoma on the distal phalanx tip of the second toe, without scintigraphy fixation and obvious nidus on X-ray and CT scan.

Serially recurrent osteoid osteoma

Osteoid osteoma is a relatively common, benign, painful tumor of bone. It is widely believed to run a course culminating in spontaneous regression. The tumor can usually be eliminated by excision or ablation, although it may recur locally. Although management has classically been surgical, thermocoagulation via percutaneously delivered radiofrequency energy has demonstrated excellent results, typically resulting in durable response following a single treatment. Here, we present an unusual case of serially recurrent pathologically proven pediatric osteoid osteoma, treated by radiofrequency ablation five times over the course of 11 years. Limitations of RF ablation of osteoid osteoma and possible factors predisposing to incomplete treatment or recurrence are discussed.

[Use of radioguided surgery in the surgical treatment of osteoid osteoma]

OBJECTIVE

Osteoid osteoma is the third most common benign bone tumor and complete surgical resection is definitive treatment. There are a limited number of publications on the use of radioguided surgery in this type of lesion. To assess the utility of radioguided surgery in our environment as a method of surgical treatment of this tumor.

MATERIAL AND METHODS

We retrospectively evaluated 12 patients (2 women and 10 men, age range 9-44 years) with clinical and radiological suspicion of osteoid osteoma. Bone scintigraphy showed foci of pathology uptake compatible with suspected lesion in the femur (4 cases), tibia (3), vertebral column (3), humerus (1) and talus (1). Subsequently patients underwent surgical treatment by radioguided surgery after injection of a dose of (99m)Tc-hydroxy diphosphonate. The nidus was removed using gamma probe and mini gamma camera, considering the technique to be completed when its counts decreased to the levels of the surrounding bone counts.

RESULTS

Lesions were located in all patients (12 of 12), and were confirmed histologically in 8 of them, including an osteoblastoma. The cure rate was 100%, based on the disappearance of pain after a minimum follow-up of 6 months.

CONCLUSION

Use of radioguided surgery in the surgical treatment of osteoid osteoma showed satisfactory results, with 100% efficiency in both lesion location and outcome of treatment and without major postoperative complications.

Osteoid Osteoma with a Multicentric Nidus: Interstitial Laser Ablation under MRI Guidance

Osteoid osteoma (OO) is a common benign tumor of the bone and is typically treated by thermal ablation with computed tomography (CT) guidance. Only a few cases of multicentric OO have been described. We here report the case of an 11-year-old boy with multicentric OO of the right femur treated with laser ablation under open high-field MRI guidance. The steps of the interventional MRI procedure are described, discussing the benefits and disadvantages of MRI versus CT guidance especially with regard to younger patients.

Case report: Osteoid osteoma of the acetabulum treated with arthroscopy-assisted radiofrequency ablation

BACKGROUND

Osteoid osteomas consist of a nidus surrounded by reactive sclerotic bone. The diagnosis typically is based on imaging and clinical presentation involving nocturnal pain. Removal of the lesion is essential and currently is performed mainly with image-guided, minimally invasive techniques. We describe a case involving an osteoid osteoma of the acetabular fossa, treated with arthroscopy-assisted radiofrequency ablation.

CASE DESCRIPTION

A 47-year-old woman presented with a 9-month history of right groin pain and limited motion. The CT and MR images showed synovitis around the ligamentum teres and a nidus of the acetabular fossa, surrounded by sclerotic bone and protruding from the inner part of the lamina quadrilateral. Synovectomy and debridement of the ligamentum teres were performed, followed by radiofrequency ablation of the osteoid osteoma under direct arthroscopic observation of the hip, avoiding resection of the normal bone around the nidus and preserving the integrity of the quadrilateral lamina and cartilage. The patient had complete pain relief the next day with minimal morbidity and rapid functional restoration. At the 22-month clinical followup, the patient was asymptomatic, and the CT and MR images obtained 1 year after surgery showed no pathologic signs or synovitis.

LITERATURE REVIEW

Our case was the fifth such case to be treated with hip arthroscopy and the first of these to our knowledge to be treated with the arthroscopy-assisted radiofrequency ablation technique.

PURPOSES AND CLINICAL RELEVANCE

Arthroscopy-assisted radiofrequency ablation is a combined treatment technique that may be used for intraarticular lesions of the hip that otherwise would require a difficult approach and jeopardize damage to cartilage and bone and also treat concomitant synovitis.

Gamma probe guided surgery for osteoid osteoma: is there any additive value of quantitative bone scintigraphy?

OBJECTIVE

The aim of this study is to evaluate the efficiency of gamma probe guided osteoid osteoma surgery and the applicability of quantitative analyses obtained from preoperative bone scan images.

MATERIAL AND METHODS

This study involved 12 osteoid osteoma patients who were treated with gamma probe guided surgery after preoperative bone scan. The calculated contrast ratios between nidus and adjacent healthy bone from preoperative bone scan and the calculated percentages of count reduction after resection of nidus during intraoperative gamma probe application were compared. Patients were followed up for any recurrence or complications.

RESULTS

The mean contrast ratio between nidus and adjacent healthy bone calculated from preoperative bone scan was 43.6% (range 33-53%). Following the nidus excision, an average of 55.8% (range 28-73%) count reduction was estimated with gamma probe in the tumor area. There was no correlation between preoperative scintigraphic contrast ratio and intraoperative gamma probe count reduction ratio (r = 0.46, p = 0.13). Complete cure was achieved in 11 (92%) patients with single operation, during the postoperative follow up period. None of the patients had any major or minor complications during or after the surgery.

CONCLUSIONS

Due to high clinical success and low complication rate in osteoid osteoma surgery, gamma probe application is an effective and safe method that should be used more extensively in daily practice.

Osteoid osteoma mimicking Brodie's abscess in a 13-year-old girl

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.

Interstitial laser photocoagulation for the treatment of osteoid osteoma: retrospective study on 35 cases

PURPOSE

The aim of our retrospective study was to evaluate the efficacy of interstitial laser photocoagulation for the treatment of osteoid osteomas and to identify the factors leading to failure of the procedure.

MATERIAL AND METHODS

Thirty-five patients received interstitial laser photocoagulation treatment. A minimum of 3 months follow-up was required. The laser fibre was positioned within the nidus under CT guidance, and energy between 500 and 1800 J was delivered at a power of 2 Watts/s. Follow-up was by outpatient appointment and through a questionnaire sent to the patients.

RESULTS

Thirty patients replied to the questionnaire. Mean follow-up was 40 months. The technical success rate was 100%. The primary success rate (no pain at 1 month) was 94.3%. The rate of recurrence was 6%. The rate of complications was 11.4% (a skin burn, patellar enthesopathy, a broken item of material, sacro-iliac fibrous alterations). Factors likely to favour failure of the procedure are the size of the nidus (P=0.04) and poor positioning of the laser fibre (P=0.03).

CONCLUSION

Interstitial laser photocoagulation is an effective and safe treatment for osteoid osteomas.

Osteoid osteoma of the proximal fibula: an uncommon location with the indication for open surgery

Purpose. This is a case report of a patient with an osteoid osteoma of the proximal fibula. The objective is to illustrate a rare tumor location that requires open surgery due to closeness of neurological structures. Methods. Clinical and roentgenographic findings, treatment, and histological appearance are presented. Results. Local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma, what was confirmed with an MRI scan. Due to proximity to the common peroneal nerve, we decided for open surgery. During the operation, the nerve was seen to cross the tumor site making it necessary to retract it to expose the entire tumor. Histologically, typical features of osteoid osteoma with a rather well-defined nidus surrounded by sclerotic bone were seen. A complete removal was performed. Conclusion. Osteoid osteomas of the proximal fibula are rare. When planning surgery, the common peroneal nerve must be identified, and its further distal course should be taken into account to avoid iatrogenic damage to the nerve.

Recurrent osteoid osteoma: interstitial laser ablation under magnetic resonance imaging guidance

Thermal ablation has become a therapy of choice in the treatment of osteoid osteomas. To date, computed tomography has been the standard imaging modality for minimally invasive treatment regimes. We report a case of a 46-year-old man with a recurrent osteoid osteoma in the right tibial head after CT-guided drill excision and repeat treatment with laser ablation under open high-field MRI guidance. We describe the steps of the interventional MRI procedure and discuss related innovative guidance and monitoring features, and potential benefits of MRI compared with CT-guided techniques. In conclusion, MR-guided laser ablation was proved to be safe and effective.

Radiofrequency ablation of osteoid osteoma in atypical locations: a case series

BACKGROUND

Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones.

QUESTIONS/PURPOSES

We determined the pain relief and complication rates after radiofrequency ablation of osteoid osteomas presenting in atypical locations and followed patients to assess possible recurrence or late complications.

PATIENTS AND METHODS

We retrospectively reviewed 21 patients with osteoid osteomas in unusual locations (eg, hip, radioulnar joint, and proximal phalanx) in whom we used radiofrequency ablation. Postoperative activities were not restricted for any of the patients. We assessed the time for patients to become symptom free, their activity status, and possible recurrence or complications. The minimum clinical followup was 12 months (mean, 27.8 months; range, 12-37 months).

RESULTS

All patients became symptom free within 24 hours to 1 week. During followup, none of the patients experienced recurrence or any major complications.

CONCLUSIONS

Radiofrequency ablation for osteoid osteomas in unusual locations reliably relieves pain with few complications and recurrences at short-term followup.

LEVEL OF EVIDENCE

Level IV, case series. See Guidelines for Authors for a complete description of level of evidence.

Osteoid osteomas in common and in technically challenging locations treated with computed tomography-guided percutaneous radiofrequency ablation

OBJECTIVE

To evaluate the efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation for the treatment of osteoid osteomas in common and in technically challenging locations.

MATERIALS AND METHODS

Twenty-three patients with osteoid osteomas in common (nine cases) and technically challenging [14 cases: intra-articular (n = 7), spinal (n = 5), metaphyseal (n = 2)] positions were treated with CT-guided RF ablation. Therapy was performed under conscious sedation with a seven-array expandable RF electrode for 8-10 min at 80-110 degrees C and power of 90-110 W. The patients went home under instruction. A brief pain inventory (BPI) score was calculated before and after (1 day, 4 weeks, 6 months and 1 year) treatment.

RESULTS

All procedures were technically successful. Primary clinical success was 91.3% (21 of total 23 patients), despite the lesions' locations. BPI score was dramatically reduced after the procedure, and the decrease in BPI score was significant (P < 0.001, paired t-test; n-1 = 22) for all periods during follow up. Two patients had persistent pain after 1 month and were treated successfully with a second procedure (secondary success rate 100%). No immediate or delayed complications were observed.

CONCLUSION

CT-guided RF ablation is safe and highly effective for treatment of osteoid osteomas, even in technically difficult positions.

[Osteoid osteoma. X-ray-controlled resection and histologic verification using a minimally invasive diamond bone-cutting system]

BACKGROUND

In recent years, osteoid osteomas have been treated more frequently by means of percutaneous procedures. The main disadvantage in patients with suspected osteoid osteoma is the lack of histological verification. Our study presents the results that we obtained using a minimally invasive diamond bone-cutting system allowing histologic verification.

MATERIALS AND METHODS

Six patients (age 10-20 years) with osteoid osteoma in the lower extremities were subjected to resection of the nidus using a minimally invasive water-cooled diamond bone-cutting system. All specimens were histologically processed and diagnosed.

RESULTS

In all patients the nidus was resected successfully, and the diagnosis was histologically confirmed. The mean operating time was 22.8 min. All patients were allowed full weight-bearing immediately, and hospitalization was a maximum of 2 days. All patients were free of pain and relapse-free during the entire 2-year postoperative follow-up.

CONCLUSION

In selected localizations with a clearly visible nidus, the minimally invasive diamond bone-cutting system presented here offers an alternative to the established surgical and percutaneous procedures for treating osteoid osteomas. This procedure combines the advantages of a minimally invasive technique with the option of histological verification of the diagnosis and correct nidus ablation.

MR-guided laser ablation of osteoid osteoma in an open high-field system (1.0 T)

Computed tomography is the standard imaging modality to minimize the extent of surgical or ablative treatment in osteoid osteomas. In the last 15 years, since a description of thermal ablation of osteoid osteomas was first published, this technique has become a treatment of choice for this tumor. We report the case of a 20-year-old man with an osteoid osteoma treated with laser ablation in an open high-field magnetic resonance imaging scanner (1.0 T). The tumor, located in the right fibula, was safely and effectively ablated under online monitoring. We describe the steps of this interventional procedure and discuss related innovative guidance and monitoring features and potential benefits compared with computed tomographic guidance.

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision.

Percutaneous radiofrequency thermocoagulation of osteoid osteomas: factors affecting therapeutic outcome

OBJECTIVE

To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation.

DESIGN AND PATIENTS

A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 months.

RESULTS

There were seven local recurrences (16%); all occurred within the first year. Local recurrence was significantly related to a non-diaphyseal location (P<0.01). There was no significant relationship (P=0.05) between local recurrence and age of the patient, duration of symptoms, previous treatment, size of the lesion, positive biopsy, radiofrequency generator used or the number of needle positions. There were no complications.

CONCLUSIONS

Osteoid osteomas in a non-diaphyseal location are statistically more likely to recur than those in a diaphyseal location when treated with CT-guided percutaneous radiofrequency thermocoagulation. This relationship between local recurrence and location has not been previously reported.

Bone-forming tumors of the upper extremity and Ewing's sarcoma

This article presents an overview of bone-forming tumors that occur in the upper extremity. Osteoid osteoma, osteoblastoma, osteosarcoma, and Ewing's sarcoma are covered. Each tumor type is described, and suggestions are made for diagnostic workup and differential diagnosis. Locations in the upper extremity where each tumor typically occurs are given. Preferred treatment regimens and incidence of recurrence are also presented.

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.

"Occult" roentgenographic osteoblastoma of the cervical spine

A 33-yr-old man presented with a 4-yr history of neck pain. Previous work-ups, including planar radiographs and magnetic resonance imaging, were determined as "normal" by six previous consultants. In a subsequent in-office evaluation by a physiatrist, a vertebral osteoid osteoma or carotid artery angiitis was clinically suspected. A bone scan of the cervical spine was consistent with a the presence of an of osteoid osteoma. Thereafter, repeat magnetic resonance imaging confused the issue by suggesting the presence osteomyelitis involving the C3-C4 facet joint. Spiral cervical spine computed tomography with digital reconstruction once again demonstrated the presence of an osteoblastoma. The patient was subsequently referred to a spinal surgeon for biopsy and resection, which confirmed the presence of an osteoblastoma. Although benign cervical neoplasms presenting as neck pain occur most often in a pediatric population, at any age, the differential diagnosis of intractable neck pain should include the possibility of a primary osseous or metastatic tumor.