Percutaneous Treatment of Osteoid Osteomas: Combination of Drill Biopsy and Subsequent Ethanol Injection

Abstract

Osteoid osteoma is known as a benign bone-producing tumor. Histologically, it is characterized by a highly vascularized connective tissue with fibrous bone trabeculae, osteoid, osteoblasts, and numerous osteoclasts. Clinically, patients complain of pain during the night with good response to acetylsalicylic acid. Conventional radiographs show a spindle-shaped lesion with a central lucency not larger than 1 cm in size, which represents the nidus. Osteoid osteomas are most common in the diaphysis of the long bones. A successful therapy requires complete removal of the nidus, either surgically or percutaneously. Our experience is with CT-guided percutaneous drilling of the nidus with subsequent ethanol injection to sclerose remnants of the nidus.

Magnetic Resonance Imaging Diagnosis and Computed Tomography-Guided Radiofrequency Ablation of Osteoid Osteoma

“…Newer treatment options for osteoid osteoma include various imaging guided interventions, such as percutaneous laser photocoagulation, ethanol injection, and, more commonly, percutaneous radiofrequency (RF) ablation [9][10][11][12]. For radiofrequency ablation, fluoroscopic, or, more commonly, CT guidance, is used to guide an RF probe into the central nidus of the osteoid osteoma, which is then heated to approximately 90-C [11].…”

Radiofrequency Ablation of Intra-articular Osteoid Osteoma of the Hip

“…10,11 In addition, incomplete excision of the nidus has been associated with recurrence of pain. 10 Recently, minimally invasive techniques such as percutaneous trephine or drill resection, 12,13 with or without the subsequent injection of ethanol, 14,15 and thermal destruction with laser photocoagulation 16 or radiofrequency (RF) ablation 11,17,18 have been used for removal or destruction of the nidus. In this study, we outline the clinical results, complications and local recurrence after percutaneous RF ablation of intraarticular osteoid osteomas of the hip in 16 patients and discuss the technical aspects of the procedure.…”

Case Report: Osteoid Osteoma of the Acetabulum Treated With Arthroscopy-assisted Radiofrequency Ablation

“…CT-guided percutaneous resection has been commonly used for the past decade, especially for difficult locations like the acetabulum [43,56,62]. Other percutaneous techniques have been proposed, such as laser thermal therapy, cryotherapy, and ethanol therapy [1,2,26,27]. CT-guided RFA has become the preferred method owing to a low morbidity rate, minimal postoperative complications, minimal tissue exposure, rapid recovery, and no restriction of weightbearing activity [10,14,33,50,60,69].…”