Osteoid Osteoma; A Diagnostic Protocol and Treatment with Computed Tomography Guided Radio Frequency Ablation in a Series of 36 Patients.
Volume 7 | Issue 3 | September-December 2021 | Page: 13-16 | Sandeep Patwardhan, Arkesh Madegowda, Ashok Shyam, Parag Sancheti
DOI-10.13107/ijpo.2021.v07i03.116
Authors: Sandeep Patwardhan MS Ortho. [1], Arkesh Madegowda MS Ortho. [1], Ashok Shyam MS Ortho. [1, 2], Parag Sancheti MS Ortho. [1]
[1] Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Research, Indian Orthopaedic Research Group, Thane (W), Maharashtra, India.
Address of Correspondence
Dr Arkesh Madegowda
Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: dr.arkesh@gmail.com
Abstract
Background and purpose: Osteoid osteoma (OO) constitutes 10-12% of all benign bone tumours making it one of the most commonly occurring bone tumour. Radiofrequency ablation (RFA) offers a minimally invasive day care treatment option where in the tumour cells in the nidus are thermo-coagulated. The purpose of this study is to highlight the diagnostic protocol of OO and evaluate the safety and efficacy of RFA in its treatment.
Methods: A total of 36 patients (26 male, 10 female patients; mean age 10.33 years; age range 4-20 years) who underwent Computerized tomography (CT) guided RFA treatment for osteoid osteoma of various anatomical locations were included in this study. Patients underwent radiography and CT evaluation for diagnosis. When classical symptoms were absent and CT was inconclusive, patients underwent further evaluation with magnetic resonance imaging (MR) and nuclear scan. Features suggestive of OO in any two of these investigations was considered confirmatory and such patients were offered RFA. Patients were assessed for abolition of pain after treatment and complications if any were recorded.
Results: The intra nidus location of probe which was considered as technical success was noted in all patients. There was significant improvement in pain after RFA. Visual Analogue Scale (VAS) score improved from 7.2 preoperatively to 0.6 and 0.0 at 3 months and 6 months respectively. Two patients of tibia OO had superficial skin burns that healed within 2 weeks. One patient sustained tibia fracture at RFA site after a fall and but was pain free after 20 weeks. At the latest follow up of 28 months (range 14-56 months), there were no recurrences.
Conclusion: Diagnosis of osteoid osteoma may be challenging at times and additional investigations like MRI/nuclear bone scan along with radiography and CT aid in making an appropriate diagnosis. CT guided radiofrequency ablation of osteoid osteoma is a safe, effective and minimally invasive treatment modality with low complication rates.
Keywords: Osteoid osteoma, Computed tomography guided, Radiofrequency ablation, Minimally invasive, Day care.
References
1. Iyer RS, Chapman T, Chew FS. Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR. 2012;198(5):1039e1052.
2. D. C.Dahlin andK. K. Unni, Bone Tumours: General Aspects and Data on 8542 Cases, Springfield: III:Thomas, 4th edition, 1987.
3. Widmann G., Schullian P., Fasser M., Niederwanger C., & Bale R. (2013). CT-guided stereotactic targeting accuracy of osteoid osteoma. The International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS, 9(3), 274-279.
4. Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg. 2011 Nov;19(11):678-89.
5. Carneiro BC, Da Cruz IAN, Ormond Filho AG, Silva IP, Guimarães JB, Silva FD, Nico MAC, Stump XMGRG. Osteoid osteoma: the great mimicker. Insights Imaging. 2021 Mar 8;12(1):32.
6. Cantwell C. P., Obyrne J., & Eustace S. (2004). Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation. European Radiology, 14(4), 607-617.
7. De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V. Radiofrequency ablation of osteoid osteoma. Acta Biomed. 2018 Jan 19;89(1-S):175-185.
8. Muneeb A, Solbiati L, Brace CL, et al. Image-guided tumour ablation: standardization of terminology and reporting criteria – a 10-year update. Radiology.2014;273(1):241e260.
9. Mankin HJ: Osteoid osteoma and osteoblastoma: Two related bone tumours, in Great Educator Series: Pathophysiology of Orthopaedic Diseases. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009, vol 2, pp 79-85.
10. Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ: Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am 1998;80(6):815-821.
11. Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ: Decreasing length of hospital stay in treatment of osteoid osteoma. Clin Orthop Relat Res 1999;(361):186-191.
12. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ: Osteoid osteoma: Percutaneous treatment with radiofrequency energy. Radiology 2003; 229(1):171-175.
13. Nijland H, Gerbers JG, Bulstra SK, Overbosch J, Stevens M, Jutte PC. Evaluation of accuracy and precision of CT-guidance in Radiofrequency Ablation for osteoid osteoma in 86 patients. PLoS One. 2017 Apr 6;12(4):e0169171.
14. Peyser A, Applbaum Y, Simanovsky N, Safran O, Lamdan R: CT-guided radiofrequency ablation of pediatric osteoid osteoma utilizing a water-cooled tip. Ann Surg Oncol 2009;16(10):2856- 2861.
15. Sahin C, Oc Y, Ediz N, Altınay M, Bayrak AH. The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma. Acta Orthop Traumatol Turc. 2019 Sep;53(5):360-365.
16. Oc Y, Kilinc BE, Cennet S, Boyacioglu MM, Ertugrul R, Varol A. Complications of Computer Tomography Assisted Radiofrequency Ablation in the Treatment of Osteoid Osteoma. Biomed Res Int. 2019 May 15;2019:4376851.
17. Ankory R, Kadar A, Netzer D, Schermann H, Gortzak Y, Dadia S, Kollander Y, Segal O. 3D imaging and stealth navigation instead of CT guidance for radiofrequency ablation of osteoid osteomas: a series of 52 patients. BMC Musculoskelet Disord. 2019 Dec 1;20(1):579.
18. Scipione R, Anzidei M, Bazzocchi A, Gagliardo C, Catalano C, Napoli A. HIFU for bone metastases and other musculoskeletal applications. Semin Intervent Radiol. 2018;35(4):261e267.
19. Kishore S, Kothary N, Lugren M, Mohler D, Avedian R, Ghanouni P. Treatment of osteoid osteoma using MR guided high intensity focussed ultrasound: preliminary results after four patients. J Vasc Interv Radiol.
20. Yarmolenko PS, Eranki A, Partanen A, et al. Technical aspects of osteoid osteoma ablation in children using MR-guided high intensity focussed ultrasound. Int J Hyperthermia. 2018;34(1):49e58.
| How to Cite this Article: Patwardhan S, Madegowda A, Shyam A, Sancheti P | Osteoid Osteoma; A Diagnostic Protocol and Treatment with Computed Tomography- Guided Radio Frequency Ablation in a Series of 36 Patients | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 13-16. |
