Radiofrequency ablation of osteoid osteoma: Aiming for excellent outcomes in an Australasian context

Abstract

Introduction To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred. Methods Over a 13‐year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre. Results All patients had resolution of symptoms with no complication or recurrence. Conclusions This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma.

Computed tomography guided radiofrequency ablation of osteoid osteoma in technically challenging locations: Tracking through the opposite cortex

“…These scenarios can either be due to inadequate operating space, nidus location, unfavorable cortical topography, a reduced skin to nidus distance, presence of extensive sclerosis, or due to the presence of vital neurovascular structures in the close vicinity of the lesion. [5][6][7][8] Location of the nidus is a critical factor in determining the needle trajectory. [4] Approaching the lesion from the unaffected opposite cortex is most amenable in cortical variety of osteoid osteoma, where an approach from the overlying cortex is technically infeasible.…”

“…One of the major risks associated with this approach is increased rates of iatrogenic fractures. [1,2,6] As a major segment of the bone is breeched during the procedure, chances of significant bone weakening, fractures are substantially high. In our experience, use of bone drill with 2 mm drill bit to advance the needle into the nidus is a better technical option as compared to use of hammer.…”

“…Another important factor is the increase likelihood of marrow burns which may occur due to heat conduction from the tip of the RF probe along the length of the needle passing through the bone marrow. [6] Use of completely insulated needle can reduce the chances of "marrow burns. "…”

“…[1][2][3][4][5] The standard CT-guided RFA involves approaching the nidus through the cortex closest to the nidus as described by many investigators. [5][6][7][8] Complete ablation of the nidus is the key for successful clinical outcome. Technical success is defined as cannulation of the bone within a 2 mm radius of the nidus.…”