Complications of Computer Tomography Assisted Radiofrequency Ablation in the Treatment of Osteoid Osteoma

Abstract

Background. Osteoid osteoma (OO) is one of the most commonly occurring benign bone tumors. It constitutes 10-12% of benign bone tumors and 2-3% of primary bone tumors. In radiofrequency ablation (RFA) treatment, the cells of the tumor are thermally inactivated by the help of electrodes shaped like needles. In our study, we aimed to show the major and minor complications in patients undergoing RFA and to show what should be done to prevent these complications. Methods. The study was carried out as a prospective study on the follow-up of 87 osteoid osteoma patients treated between 2015 and 2017. The youngest of the patients was 1 year old and the oldest was 42 years old. The RFA procedure lasted 10 min on average, excluding anesthesia and preparation. All lesions were ablated at 90 degrees for 7 minutes with the heat increased gradually. All patients were followed up for 1 day in the orthopedics clinic. Results. Complications were observed in 7 patients. The lesions with the most complications were observed to be in the tibia, second-degree burns were seen in 2 patients, and superficial skin infection was observed in 2 patients. In 1 patient, the probe tip was broken and remained within the bone. Intramuscular hematoma was detected in 1 lesion located in the proximal femur. A complaint of numbness in the fingers developed in a lesion located in the metacarpus. Conclusion. Preventive measures should be taken before the procedure in order to prevent minor complications, and, for major complications, close follow-up should be done after the procedure and patients should be kept away from heavy physical activities for the first 3 months.

Misdiagnosis and treatment of proximal femoral osteoid osteoma

“…The proximal femoral constitutes the most susceptible part for OO, which is challenging to treat because of its deep location, close to the hip joint, and complex local anatomy [4,14,15,17,24]. Presently, the main surgical treatment methods for OO include open surgical resection and minimally invasive treatment, such as CT guided radiofrequency ablation (RFA) [25][26][27][28], cryoablation [17], and microwave ablation [29]. Whatever the kind of treatment adopted, the key to successful surgical treatment of OO is based on the accurate location of the nidus and its subsequent complete removal [3][4][5][6].…”

“…However, it requires high hardware conditions, high technical operation requirements, presents with incomplete removal of the nidus, easy to damage adjacent tissues, and unable to carry out a pathological examination, and among other limitations, which affect its popularization and application [8,17,25,[30][31][32]. At the same time, minimally invasive surgery is signi cantly inferior to open surgical resection in terms of OO recurrence rate and incidence of complications [25,29,33,34]. The trauma associated with open surgery is relatively higher but wholly and accurately results in the removal of the nidus, improving the positive rate of pathological examination, and reduces the postoperative recurrence rate.…”

“…This causes considerable physical suffering and nancial burden. Through comparative analysis, we found that the complex and diverse clinical manifestations of proximal femoral OO cause its objective misdiagnosis, whereas lack of clear understanding of the disease and selection of the wrong method of examination constitute the frequent subjective causes of misdiagnosis [6,25,[34][35][36]. OO is characterized by persistent pain, accompanied by nocturnal pain, which is relieved by oral use of NSAIDs.…”

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

“…In a study on atypical localizations, Akhlaghpour et al[ 6 ] reported skin burns in a patient with phalanx localization. Oç et al[ 25 ] reported that two of 87 patients exhibited second-degree skin burns in the anterior part of the tibia and one patient with metacarpal localization experienced numbness. Based on these data, traditional open surgery may be recommended as the primary treatment, particularly in localizations having insufficient soft tissue support, localizations close to neurovascular structures, and some atypical localizations.…”

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art

“…The complication rate is low (range: 1-6%). 30 The most common complication is a skin burn in the treated site, followed by local infection, necrosis of the adjacent structures, and postintervention fractures. Minor complications are loss of sensitivity in the treated site that generally improves spontaneously in 2 weeks.…”