Osteoid osteoma: excision with scintimetric guidance

[Place of intraoperative isotopic markers in the management of osteoid osteoma]

L'ostéome ostéoïde est une tumeur osseuse bénigne. Le diagnostic est clinique et radiologique, et le traitement consiste en l'exérèse chirurgicale totale avec des marges saines. Nous rapportons 05 cas d'ostéome ostéoïde opérés avec succès à l'aide d'un repérage isotopique peropératoire. Nous précisons les avantages de cette technique dans l'orientation de l'exérèse chirurgicale ainsi que la confirmation de son caractère radical.

Resection of osteoid osteoma of distal tibia using the intraoperative isotopic scan

Osteoid osteomas are small-sized benign painful bony tumors. The authors report the case of an osteoid osteoma located in the distal third of the tibia, treated by the surgical excision of the nidus using the intraoperatively isotopic marking which allows reducing the incision size and the bony resection.

Follow-up of thirty-three computed-tomography-guided percutaneous radiofrequency thermoablations of osteoid osteoma

PURPOSE

This study aimed to determine the mid- and long-term success and complication rates of radiofrequency ablation (RFA) in treatment of osteoid osteoma (OO). Furthermore we were interested in the value of bone biopsy when using a core-drill before the radiofrequency ablation.

METHODS

We retrospectively analysed data of 33 patients (33 osteoid osteomas, 22 males, 11 females) who underwent computed-tomography (CT) guided radiofrequency ablation between 1998 and 2005. The patients had a mean age of 20 years (range, five to 50 years). They were monitored for a mean follow-up of 92 months (range, 60-121 months).

RESULTS

Lesions were located as follows: 11 cases in the proximal femur, five in the femoral shaft, six in the tibia, one in the calcaneus, two in the metatarsals (second and fourth metatarsals), one in the os cuneiforme mediale, six in the humeral and one in the ulnar shaft. Within the presented time frame 32 of 33 patients were successfully treated and had no more complaints. In one of 33 patients relapse occurred after 28 months and RFA was repeated. There were no complications associated with the procedure. Biopsy obtained prior to thermocoagulation with the help of a core-drill was able to prove diagnosis in all patients (100%).

CONCLUSIONS

These results indicate that the presented technique of CT guided RFA combined with the use of a core-drill for biopsy prior to RFA treatment is a highly effective, efficient, minimally invasive and safe method for the treatment of OO, yielding a success rate of 97% combined with a 100% histological verification of the diagnosis after a minimum follow-up period of five years.

Role of intraoperative 3D C-arm-based navigation in percutaneous excision of osteoid osteoma of long bones in children

Failures of treatment of osteoid osteoma (OO) are related to errors in exact localization and incomplete excision of the nidus. We report the successful percutaneous excision of OO in five patients (upper end of femur - 3, tibia - 2). All patients had a minimally invasive reflective array fixed to the same bone followed by registration of anatomy by Iso-C three-dimensional (3D) C-arm. A tool navigator was used to plan the keyhole incision then a sleeve was introduced which allowed the usage of burr and curette to remove the tumor. After excision, the 3D C-arm was again used intraoperatively to confirm the complete eradication of the nidus. Adequate material for histology was obtained in four patients that confirmed the diagnosis of OO. In one child postexcision scans were successful in identifying incomplete removal requiring further excision of the nidus. All patients achieved excellent pain relief and were asymptomatic at an average follow-up of 3.2 years. 3D C-arm-based navigation offers the advantage of excellent localization, percutaneous excision, and intraoperative confirmation of adequate excision.

Open resection of osteoid osteoma guided by a gamma-probe

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.

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

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

Intraoperative localization of an osteoid-osteoma using a gamma probe

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.

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.

[Left distal femoral diaphysis-metaphyseal injury in a 13-year-old patient]

This paper aims to present the usefulness of the different diagnosis imaging methods (anatomical and functional) in the characterization of bone injury. Any data, however insignificant, is justified and should be specified. In this case, the discrepancy between the vascular and pool phases in the bone scintigraphy with 99mTc-MDP reveals revealed a lesion with an intense reaction secondary to the "foreign body effect", which is not necessarily malignant.

Percutaneous resection of osteoid osteoma under CT guidance in eight children

In eight children with suspected osteoid osteoma, a percutaneous resection under CT guidance was performed. The specific drill resection system we currently use includes a 7-mm-diameter toothed drill. Osteoid osteomas were located in the appendicular skeleton in seven children and in the spine (second lumbar vertebral body) in one. All eight patients were successfully treated with complete relief of pain. There was no recurrence of symptoms during a follow-up period of 8-35 months. CT guidance was accurate enough to allow a focal bone excision, and no subsequent bone repair was needed. Histological confirmation was obtained in all cases. This simple and safe technique, when feasible, seems to be an effective means of treatment of osteoid osteoma in children.

Computed tomography of osteoid osteoma

Computed tomography revealed a radiolucent nidus with a surrounding zone of osteosclerosis in 17 patients with osteoid osteoma. Plain films did not reveal any abnormality in 5 patients. Conventional tomography was negative in 3 patients. Computed tomography is the modality of choice for detection of osteoid osteoma when the lesion is deep-seated or when it occurs in complex anatomic regions with curvilinear and overlapping surfaces, such as acetabulum, knee, and spine.