CT引导下经皮穿刺骨样骨瘤射频消融术

目的探讨CT引导下经皮穿刺骨样骨瘤射频消融术手术方法及临床疗效观察。方法2003年12月至2006年6月共治疗42例术前影像学诊断为骨样骨瘤的患者。男29例，女13例；年龄13-46岁，平均23．6岁；病程15d-2年，平均5个月。病灶部位：股骨近端15例，股骨远端2例，胫骨13例，骨盆7例，肱骨干2例，尺骨鹰嘴1例，跟骨1例，L4椎体1例。在腰麻或臂丛麻醉下行CT定位引导经皮穿刺射频消融术。术中CT扫描层厚为2-4mm，治疗温度90℃持续6min，用直径3．5-4mm穿刺针穿透骨皮质，将有效治疗直径1．5-2．0cm的射频电极准确插入瘤巢中心。随访18-24个月，平均19．5个月。手术前后行MR病灶扫描，进行影像学对比。疼痛视觉类比评分法（visual analoguescore，VAS）作为临床疗效评定参数。结果术后24h所有患者自主下地活动，术后3d-1周疼痛症状明显减轻，术后1个月随访疼痛基本消失。VAS评分明显降低，差异有统计学意义（P〈0．01）。术后37例病理结果证实为骨样骨瘤，其余5例因取材失败，病理结果为阴性。术中、术后无严重并发症，治疗成功率93％，末次随访无复发。术后复查MRT2加权像有不同程度信号降低。结论CT定位引导下经皮穿刺射频消融治疗骨样骨瘤是一种简单、微创、安全、高效的技术，射频消融电极针精确到达瘤巢是治疗成功的关键。     

Percutaneous radiofrequency ablation in osteoid osteoma

We treated 58 patients with osteoid osteoma by CT-guided radiofrequency ablation (RF). In 16 it followed one or two unsuccessful open procedures. It was performed under general anaesthesia in 48, and spinal anaesthesia in ten. The nidus was first located by thin-cut CT (2 to 3 mm) sections. In hard bony areas a 2 mm coaxial drill system was applied. In softer areas an 11-gauge Jamshidi needle was inserted to allow the passage of a 1 mm RF probe into the centre of the nidus. RF ablation was administered at 90 degrees C for a period of four to five minutes. Three patients had recurrence of pain three, five and seven months after treatment, respectively, and a second percutaneous procedure was successful. Thus, the primary rate of success for all patients was 95% and the secondary rate was 100%. One minor complication was encountered. CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma.     

Percutaneous radiofrequency ablation of osteoid osteoma

Osteoid osteoma is a benign bone tumor. Patients usually require surgical treatment for reliable pain relief. Difficulties with intraoperative localization of the tumor and anatomic locations that carry a high morbidity with en bloc resection complicate open surgery. Various methods have been developed to lessen the invasiveness of surgery including computed tomography-guided percutaneous radiofrequency thermal ablation. Eleven patients in three different centers were evaluated and diagnosed with osteoid osteoma based on typical histories, physical examinations, and imaging studies. All patients were treated with computed tomography-guided percutaneous radiofrequency thermal ablation after medical treatment failed. Excellent pain relief was reported in 10 patients. One patient suffered recurrence of a femoral neck lesion despite an initial 7-month period without pain. Patients were given a questionnaire to quantify the effectiveness of percutaneous radiofrequency ablation in terms of pain relief and return to function. The current study shows that percutaneous radiofrequency thermal ablation provides reliable, excellent pain relief and early return to function with minimal morbidity as compared with traditional open techniques. The authors suggest that this technique be used for all patients with extraspinal osteoid osteomas that are not immediately adjacent to neurovascular structures.     

Radiofrequency ablation in osteoid osteoma of the finger

The occurrence of osteoid osteomas of the hand is rare and their treatment usually is surgical. A 26-year-old man with an osteoid osteoma in the proximal phalanx of the right middle finger was treated with percutaneous radiofrequency ablation. Two years later he remains free of pain and finger function is normal.     

CT-guided microwave ablation of osteoid osteoma: Long-term outcome in 28 patients

PurposeThe purpose of this study was to assess the long-term efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteoma. Secondary objectives were to assess early outcome and side-effects of MWA.Materials and methodsTwenty-eight consecutive patients (18 men, 10 women) with a median age of 19.5 years (IQR: 16, 25.5) with a total of 28 non-spinal osteoid osteoma treated by CT-guided MWA were retrospectively included. The ablations were performed with a median power and duration of 60 Watt and 1 min 30 s, respectively. Pain referred to osteoid osteoma was assessed at predefined time points using a 0-10 numeric rating scale. At one month, contrast-enhanced follow-up MRI was performed to evaluate the nidus vascularization and the volume of necrosis induced by MWA. Clinical success was defined by the absence of osteoid osteoma-related pain, and technical success was defined by the presence of necrosis of the nidus on the one-month post-MWA MRI.ResultsLong term success rate was 93% (26/28) after a follow-up of 55.5 months (IQR: 25.75, 74.5) and technical success rate was 96 % (25/26). One late failure was observed after a patient had been declared cured at one month but the formal proof of a late recurrence of osteoid osteoma could not be brought. Three minor complications were reported including mild reversible superficial radial nerve injury with a skin burn (grade 2) in one patient and moderate skin burn only in two patients.ConclusionOur results suggest that CT-guided MWA is an effective option for a minimally-invasive treatment of osteoid osteoma with a low rate of complication and no late recurrence.     

Radiofrequency ablation of osteoid osteoma in the upper extremity

PURPOSE: To examine the results of radiofrequency ablation (RFA) of osteoid osteoma in the upper extremity. METHODS: Twenty-nine patients with a clinical and radiographic diagnosis of an upper-extremity osteoid osteoma were referred for treatment between 1990 and 2003. All had computed tomography-guided percutaneous RFA performed by the senior investigator. Records were reviewed for patient age and gender, lesion size and location, prior treatment, and pathology results. Outcomes were determined by questionnaire via mail or telephone. Complete success was defined as complete resolution of pain without further treatment. Partial success was defined as occasional pain with activities that did not require another procedure. Failure was defined as recurrence, no change in symptoms, and/or the need for another procedure. RESULTS: Follow-up data were available for 25 patients at a minimum of 1 year. Lesion locations included 17 humerus, 5 scapula, 2 radius, 1 ulna. Results for 19 patients were rated completely successful, 4 were rated partially successful, and 2 were rated failures. Two patients whose results were not completely successful received decreased RFA temperature or duration because of the proximity of a neurovascular bundle. There were no complications. Outcomes did not correlate with any patient or tumor characteristics. CONCLUSIONS: Radiofrequency ablation is a safe and effective treatment for most osteoid osteomas in the shoulder, arm, and forearm. Lesions that do not allow a safe distance between the electrode and a major neurovascular structure may require surgical excision. This may be of particular importance in lesions of the hand and carpus. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

High-frequency radio-wave ablation of osteoid osteoma in the lumbar spine

The authors report on the first known application in the spine of percutaneous ablation of osteoid osteoma using radio-frequency waves. The technique involves a CT-guided biopsy of the lesion followed by introduction of a 1-mm probe connected to a radio-frequency lesion generator. The procedure was performed on an outpatient basis and the patient experienced immediate relief of his symptoms. No evidence of recurrence was demonstrated 16 months later. The techniqe described may become the procedure of choice in the surgical treatment of osteoid osteoma, as it minimises surgical trauma and post-operative pain. Longer follow-ups are required to monitor the incidence of recurrence. Received: 31 January 1998 Revised: 16 April 1998 Accepted: 24 April 1998     

Percutaneous radiofrequency ablation for spinal osteoid osteoma and osteoblastoma

Purposes

We sought to verify the efficacy and safety of RFA in spinal OO and osteoblastomas (OB) (Enneking Stage 2, S2).

Methods

We retrospectively reviewed patients treated in our hospital. Surgical resection was indicated for Enneking Stage 3 OB. RFA indications for spinal OO and OB (S2) were no neurological deficits, complete bone cortex around the lesion on computed tomography (CT), and cerebrospinal fluid between a lesion and the spinal cord/nerve root on magnetic resonance imaging. Abundant cerebrospinal fluid (more than 1.0 mm) between the lesion and nerve root/spinal cord was preferred to prevent neurological damage by heat. Otherwise, surgery was recommended. The minimum follow-up was 24 months.

Results

Ten patients were treated with CT-guided percutaneous RFA, including three with OB and seven with OO. No patients had neurological deficits or scoliosis. In OO patients, the average visual analog scale (VAS) scores were 7.6/10 (range 6–10) before RFA. In OB cases, the VAS scores were 8, 7, and 9 before RFA. Nine patients had a one-stage biopsy and then RFA, and one patient had a two-stage procedure (biopsy before RFA). The average RFA time for OO was 10 min (range 4–12). In the three OB cases, the RFA time was 12, 12, and 24 min. The time of the whole produce was 98 min (range 65–130 min). All 10 patients were followed-up. The average follow-up time of OO was 46.6 months (range 24–66). Six patients were free of pain, except one who suffered occasional pain with VAS 2/10. The three OB cases were free of pain at 24, 26, and 26 months.

Conclusion

CT-guided percutaneous RFA is a safe and effective treatment for spinal OO and S2 OB, especially in lesions with no neurological deficits and intact cortical bone. Cerebrospinal fluid around the lesion is an appropriate indication for percutaneous RFA.

     

Interstitial laser photocoagulation for the treatment of osteoid osteoma

We report the results of a prospective study of 23 patients in which interstitial laser photocoagulation (ILP) was used to treat an osteoid osteoma. ILP is a technique in which tumour tissue is destroyed by direct heating using low-power laser light energy delivered by thin (400 microm) optical fibres which are introduced percutaneously into the tumour under image guidance. Pain was evaluated before operation and at the latest follow-up using a visual analogue scale with 0 denoting no pain and 10 the worst pain imaginable. The mean follow-up was for 15 months. The results showed that the mean pain score decreased from 7.5 before operation to 0.95 at the latest follow-up. Fourteen patients had no pain and eight had minor discomfort, not requiring analgesia. One patient required a second procedure because placement of the fibre had not been accurate enough and one developed recurrent symptoms eight months after treatment. All patients were satisfied with the operation because of the rapid resolution of pain, the minimally invasive nature of the procedure, and the fact that there was no postoperative restriction of activity.     

Juxta-articular osteoid osteoma

Osteoid osteomas that arise at the end of a long bone, within the insertion of the joint capsule (juxta-articular, intra-articular), may cause misleading clinical, radiographic, and histologic findings, resulting in unnecessary diagnostic tests and a delay in definitive treatment. To clarify optimum diagnostic procedures, we reviewed 20 cases of juxta-articular osteoid osteomas and found a mean delay from presentation to correct diagnosis of 24 months. Plain radiographs were either negative or showed only secondary changes. A periosteal reaction and proliferative synovitis with chronic inflammation was common, which could be misinterpreted as rheumatoid arthritis. Optimum diagnostic procedures were a bone scan followed by plain tomograms and an excisional biopsy of the nidus.     

Prostaglandins in osteoid osteoma

Summary Osteoid osteoma is a tumour of bone characterised by pain which is relieved by aspirin and nonsteroidal anti-inflammatory drugs. Very high levels of prostaglandins have been found in the lesion. In five patients with osteoid osteoma, prostaglandin E ₂ (PGE ₂ ) and prostacyclin (PGI ₂ ) synthesis in the nidus yielded 1155.6±496.5 (mean±SD) and 245.2±89.8 pg/mg respectively, values which are 33 and 26 times higher than in fragments of normal bone. The sclerotic bone around the nidus produced both prostaglandins at the same rate as normal bone. In three patients the excretion rate of the major urinary metabolite of systemic PGI ₁ was reduced to 50% one month after removal of the tumour. The urinary excretion rate of 6-keto-PGF ₁ , reflecting intrarenal PGI ₂ synthesis, was not changed after operation. These results offer new insight into the pain mechanism in osteoid osteoma.

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Résumé L'ostéome ostéoïde est une tumeur osseuse caractérisée par des douleurs qui sont calmées par l'aspirine et les anti-inflammatoires non stéroïdiens. Des taux très élevés de prostaglandines ont été trouvés dans cette lésion. Chez trois malades présentant un ostéome ostéoïde la prostaglandine E ₂ (PGE ₂ ) et la prostacycline (PGI ₂ ) synthétisés dans le nidus atteignaient respectivement 1155.6±496.5 et 245.2±89.8 pg/mg, valeurs qui étaient 33 et 26 fois plus élevées que dans des fragments d'os normal. L'os scléreux entourant le nidus produisait les deux prostaglandines au même taux que l'os normal. Chez trois malades le taux d'excrétion des principaux métabolites urinaires de la PGI ₂ systémique était réduit de moitié un mois après l'ablation de la tumeur. Le taux d'excrétion urinaire de la 6-keto-PGF1, traduisant la synthèse rénale de la PGI ₂ , n'a pas été modifié par l'opération. Ces résultats permettent une nouvelle approche du mécanisme de la douleur dans l'ostéome ostéoöide.

     

Vertebral osteoid osteoma

The early diagnosis of vertebral osteoid osteoma is frequently delayed due to the absence of radiographic changes. A bone scan is more helpful because it shows an increased uptake of isotope when plain radiographs still appear normal. The use of computed tomography will confirm the diagnosis, allow precise delineation of the lesion and enable planning of the correct operation.