Osteoid osteoma of the hand and foot in children successfully treated with radiofrequency neurotomy probes

Abstract

Osteoid osteoma is a common benign tumor that is typically found in young adults and children, usually in the long bones of the lower extremity. Radiofrequency ablation (RFA) under computed tomography guidance is the standard of care for symptomatic osteoid osteomas. However, patients with osteoid osteoma of the hand or foot are often treated with open surgery because of the risk of injury to vascular and neural structures from RFA. This risk is more pronounced in pediatric patients because of the small lesion size and proximity of lesions to important neurovascular structures. Here, we present 2 pediatric patients, one with an osteoid osteoma in the hand and the other with an osteoid osteoma in the foot. In both patients, a 22-gauge, 2.5-mm active tip ablation probe was used. The smaller ablation volume achieved with this probe protected neighboring neurovascular structures while effectively ablating the osteoid osteoma nidus. Based on our success in these cases, we recommend the application of this method for cases in which neurovascular proximity to the osteoid osteoma lesion makes ablation challenging.

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

“…These allow the safe removal of the nidus and surrounding sclerosis. Nevertheless, percutaneous procedures such as radiofrequency ablation (RFA) show successful results in treating OO in the bones of the hand and have the advantage of low trauma [ 34 , 35 , 36 ]. A central CT-guided puncture of the nidus is necessary, whereby the close relationship to nerves, tendons, and vessels with the risk of unintentional damage should be considered [ 15 , 37 ].…”

Osteoid osteoma in the bones of the hand: a systematic literature review

“…It leads to good outcomes and a low morbidity [39]. When used for lesions in the hand and feet RFA must be used with caution as there is a risk of subsequent osteonecrosis or thermal damage to adjacent neurovascular structures [22,30,32]. When treating OO by RFA, it is important to reach inside the nidus to eliminate the lesion entirely [39].…”

Successful percutaneous treatment of osteoid osteoma in a 13 month-old boy with radiofrequency ablation under CT guidance

“…There can be a hesitation about RFA in preschool children because of the small body mass and high complication risks because of close proximity of lesions to neurovascular structures 15 . We can overcome damaging the neurovascular structures through ultrasound/Doppler-ultrasound guidance while inserting the needle and preventing a skin burn through cold application on the skin around the needle during RFA.…”

“…Diagnosis of OO can be challenging under the age of 5 and diagnosis is made according to specific radiological and clinical findings 9, 10, 11, 12. In treatment, radiofrequency ablation (RFA) has a high technical and clinical success and it has been standard treatment method in general population 13, 14, 15, 16, 17. However, there is limited data about its use in pediatric population, especially under 5 years of age 6, 7.…”