Minimal invasive intralesional excision of extremity-located osteoid osteomas in children

Abstract

In this retrospective study, we evaluated the efficiency of minimal invasive intralesional extended curettage in the treatment of osteoid osteomas of the extremities in children. Forty-seven children (29 males, 18 females; mean age 10.5 years; range 4-19 years) with osteoid osteoma of the extremities underwent minimal invasive intralesional extended curettage. The exact localization of the nidus was determined preoperatively by thin-section (1-1.5 mm) computed tomography scans, and complete excision of the nidus was performed using a modified burr-down technique. None of the procedures required bone grafting or internal fixation. The median follow-up duration was 59 months (range, 12-136 months). Histopathological confirmation of osteoid osteoma was achieved in all procedures. All patients experienced immediate and complete relief of lesional pain after surgery. Preoperative (a day before surgery) and postoperative (at the time of discharge) mean visual analogue scale scores, questioning the pain derived from osteoid osteoma, were 7.7±1.2 and 0.3±0.6, respectively, confirming complete removal of the nidus. Early motion of the involved extremities and mobilization of the patients were achieved within 2 days. The children resumed normal function within 3 weeks. Postoperative complication or recurrence was not encountered in any of the patients. Even though percutaneous radiofrequency thermoablation is accepted as the treatment of choice for extraspinal osteoid osteomas, this technique requires a regional reference institution. Minimal invasive intralesional extended curettage can be performed in conventional institutions, even those not specialized in bone tumor surgery, by orthopedic surgeons with high success and low morbidity rates, in addition to rapid functional recovery.

Resection of Femoral Head–Neck Junction Osteoid Osteoma via Minimally Invasive Direct Anterior Approach: A Case Series and Review of Literature

“…23 Erol et al reported immediate and complete pain relief after minimally invasive intralesional extended curettage for OOs in 47 children. 24 Rosenthal et al demonstrated complete pain relief with following CT-guided RFA in 112 of 126 (89%) procedures. 25 However, Papathanassiou et al reported pain recurrence in three OOs (10%), one intra-articular medullary, and two extra-articular cortical lesions at 2, 6 and 4 months after RFA, respectively.…”

“…They had no surgical complications, including injury to neurovascular structures, infection, and wound problems with no local recurrence after 12-month follow-up. 24 However, the femoral neck and pelvis were not included in this series.…”

Osteoid Osteoma in Children Younger than 3 Years of Age

“…In the series of Rosenthal et al [6] in 125 patients, they report one girl 3 yrs old with OO of the femur. Recently, Erol et al [7] report that 47 children with OO had a range of ages 4-19 years old. Song et al [8] report on 43 children with range 4.2 to 15.9 for the boys and 6.2 to 13.5 years for the girls.…”

“…Regarding the lesions of the femur, we completed our procedures with RF ablation, after the removal of the bone. Minimal invasive excision of OO was reported with 3-6 cm incision for the femur and gradual removal of sclerotic bone until visualization of the small nidus that appears as a red spot [7]. We preferred CT-guided biopsy as it has even less bone exposure and is safe for the subcutaneous lesions.…”

A Preclinical Pilot Study on the Effects of Thermal Ablation on Lamb Growth Plates

“…A currently used minimally invasive treatment method of osteoid osteoma, which is a benign but very painful small bone tumor, involves thermal ablation under radiographic or computed tomography-controlled application [ 6 ]. With this treatment, bone tissue is destroyed through the application of targeted heat using electrocautery.…”