Arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck

Cancellous osteoid osteoma of the talus near the subtalar joint is rare, and the treatment is very challenging. We present the first case of arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck near the subtalar joint. After confirming the nidus of the osteoid osteoma with computer tomography, the lesion was completely removed with a motorized bur under arthroscopy, and the patient’s pain disappeared immediately after surgery. This case report demonstrates that a cancellous osteoid osteoma in the talar neck near the subtalar joint can be treated by arthroscopic excision and good results could be obtained. Level of evidence IV.     

Arthroscopic removal of an osteoid osteoma of the acetabulum

In this case report, we describe the arthroscopic removal of an osteoid osteoma from the acetabulum in a young adolescent. After identifying the osteoid osteoma close to the cartilage with MRI and CT investigations, we decided that in this case, arthroscopic removal was the best treatment. In the case of an osteoid osteoma in the acetabulum close to the cartilage, arthroscopic removal should be considered as one can treat the associated osteochondritic lesion during this procedure.     

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Arthroscopic excision of osteoid osteoma in the posteroinferior portion of the acetabulum

Osteoid osteoma in the acetabulum is very rare and the surgical extirpation is difficult. We present a case of osteoid osteoma in the posteroinferior portion of the acetabulum which was treated with arthroscopic excision. A 29-year-old woman presented with 18 months of pain in the left groin. Computed tomography suggested an osteoid osteoma in the posteroinferior portion of the acetabulum. Arthroscopic excision of the lesion was performed with the aid of image intensifier. The patient’s symptoms disappeared immediately after the surgery. This case report shows that arthroscopic excision is possible in a lesion in the posteroinferior portion in the acetabulum, which previously deemed inaccessible arthroscopically.     

Osteoid osteoma: operative confirmation of complete removal by bone scintigraphy

The high sensitivity of bone scintigraphy in detecting osteoid osteoma throughout the skeleton has been documented. Recently, radioactive surgical specimens of osteoid osteomas were studied with microradiography, autoradiography, and well-counter scintimetry and were shown to concentrate most of the radionuclide within the nidus of the lesion. These techniques also proved helpful to surgeons in achieving cure with conservative bone excision. We present two cases of osteoid osteoma, one of them recurrent, in which the patients were injected with bone-seeking agent just prior to surgery. The excised specimens were immediately imaged and the entire nidus was seen, confirming the complete removal of the lesion. This simple and rapid procedure is suggested whenever difficulty is anticipated in removal of an osteoid osteoma.     

Unusual manifestation of an osteoid osteoma of the capitate

A case of osteoid osteoma of the capitate in a 29-year-old male is reported. The patient suffered from unspecific clinical findings and a 3-year history of uncharacteristic wrist pain. Conventional radiographs of the wrist revealed a circumscribed sclerosis in the proximal part of the capitate bone beside a diffuse demineralisation of the carpal bones. Magnetic resonance imaging demonstrated a circumscribed, tumorous lesion with marked enhancement after IV administration of contrast agent and a highly calcified nidus, which was sharply demarcated by a small rim of granulation tissue from the surrounding spongious bone. Based on MRI findings, the diagnosis of an osteoid osteoma was established and confirmed after operation and histologic analysis. Received: 17 December 1997; Revision received: 30 September 1998; Accepted: 7 October 1998     

Localisation and diagnosis of osteoid osteoma of the carpal area by angiography

Three patients are reported in whom the existence and exact localisation of an osteoid osteoma in the carpal area was established only by angiography. In each case demonstration of the lesion by conventional roentgenograms, including fine-section tomograms, had failed. This failure, together with initially atypical clinical symptoms, significantly delayed diagnosis, to such an extent that one patient was referred for a psychiatric opinion. The first valid diagnostic clue was provided in two cases by bone scanning, but with inadequate detail to show precisely the position of the lesion. This study re-emphasizes the value of angiography when an osteoid osteoma presents no characteristic radiological stigmata.     

Osteoid osteoma of the femur in a 7-month-old infant treated with radiofrequency ablation

Osteoid osteoma occurs most commonly in children, adolescents, and young adults between the ages of 5 and 30 years. In the preschool age group, it is quite uncommon, accounting for only 3–8% of all osteoid osteoma cases. We report a case of osteoid osteoma in a 7-month-old infant, who presented with decreased use of the right lower extremity due to pain. Magnetic resonance imaging (MRI) showed an atypical appearance. A biopsy of the lesion, with histopathological examination, confirmed the diagnosis of osteoid osteoma. Radiofrequency ablation (RFA) of the nidus under computed tomography (CT) guidance was performed. The patient developed a recurrence after 3 months, which was treated with a second RFA. On subsequent follow-up, the infant did not show signs of pain after 1 month. In summary, this case report shows that osteoid osteoma can present in early infancy and can be successfully treated with RFA at this age, however, recurrence after the procedure can occur and close follow-up is recommended.     

Arthroscopic removal of the osteoid osteoma on the neck of the talus

Juxta-articular osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus will commonly produce symptoms mimicking monoarticular arthritis or trauma. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. We present an arthroscopic removal of an osteoid osteoma on the neck of talus, and review the literature.     

Osteoid osteoma: MR imaging revisited

To assess and compare with computed tomography (CT) the performance of magnetic resonance (MR) imaging in the detection of osteoid osteoma, and determine the features of this lesion on MR imaging. The prospective MR imaging and CT diagnosis of osteoid osteoma was determined from original radiology reports. MR images were assessed retrospectively with regard to the location and signal intensity of the nidus and surrounding bone marrow and soft tissue edema. These findings were correlated with the age of the patient, duration of symptoms, and drug therapy. Ten patients with histologically proven osteoid osteoma who underwent MR imaging were reviewed. All 10 lesions were correctly diagnosed at the time of MR imaging. None of the lesions was intracortical. Nine lesions were intra-articular. Two out of five patients with extracortical lesions had false negative CT preceding the MR study. Signal intensity of the nidus, marrow, and soft tissue edema on MR imaging were variable. Perinidal edema was most pronounced in younger patients and had no apparent relation to drug therapy. MR imaging reliably demonstrates the nidus of an osteoid osteoma, which has a variable appearance related to its position relative to the cortex of the bone. A predominance of cancellous osteoid osteomas are encountered in patients referred for MR imaging. Marrow edema in the vicinity of the lesion improves the conspicuity of the nidus. CT may fail to diagnose osteoid osteoma when the nidus is in a cancellous location, due to the lack of perinidal density alteration.     

CT of osteoid osteoma of the femoral neck: the value of oblique reformatting

An osteoid osteoma is a benign bone lesion which may involve the femoral neck. The lesions are distinctively osteoblastic, containing a central fibrovascular and osteoid nidus which often evokes substantial periosteal reaction occasionally making the diagnosis by conventional radiography very difficult. Computed tomographic evaluation of these lesions at other sites has been previously reported. I wish to emphasize the unique value of CT multiplanar reformatting in a patient with an osteoid osteoma of the femoral neck.     

CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

Here we report our experience of a neuroprotective adaptation of the technique of CT-guided radiofrequency (RF) ablation of spinal osteoid osteomas. Over 9 years seven patients underwent eight CT-guided RF treatments for osteoid osteoma. CT-guided RF ablation was performed with general anaesthesia. The lesion was heated to 90°C for 2 min for two cycles by using a Cosman SMK TC-10 RF electrode. This was preceded by a bolus of room temperature sterile water (10 ml) injected through a 26G curved spinal needle into the exit foramen and adjacent epidural space for neuroprotection. The age of the patient, sex, lesion location, biopsy results and complications were recorded. All the biopsies (n = 7) demonstrated histological features of osteoid osteoma. All the procedures were technically successful. Clinical success was assessed up to 3 years post procedure. There was an 85% clinical success rate (6 of the 7 patients), with recurrence of a lesion at 6 months, necessitating a repeat procedure (successful). CT-guided percutaneous RF ablation of spinal osteoid osteoma preceded by bolus of sterile water, injected through a spinal needle into the exit foramen and adjacent epidural space for neuroprotection, is a safe and effective procedure.     

Intra-articular hip joint osteoid osteoma: Challenging diagnosis and percutaneous radiofrequency ablation treatment

Atypical intra-articular osteoid osteoma can be difficult to diagnose and challenging to treat. We report a case of a right acetabular subchondral intra-articular osteoid osteoma in a young male patient which was initially diagnosed as femoroacetabular impingement due to its atypical clinical and radiological presentations. After fully working up the patient the lesion was successfully treated with percutaneous CT-guided low-power bipolar radiofrequency ablation using several per procedural articular cartilage thermal protective measures including intra-articular thermocouple, and continuous per procedural joint space cooling with Dextrose 5% solution. A precise RFA electrode placement, using the No-touch technique, and applying different passive and active thermal protective measures were helpful in avoiding collateral damage of the hip joint articular cartilages. atypical intra-articular osteoid osteomas necessitate pertinent correlation between the clinical and radiological presentations. As far as intra-articular or subchondral nidus ablation is concerned, thermal protective measures should be considered.     

Symptomatic resolution of spinal osteoid osteoma with conservative management: imaging correlation

A 10-year-old girl presented with a history of painful scoliosis. Imaging performed, including computed tomography (CT) and magnetic resonance imaging (MRI), demonstrated a lesion with radiological features consistent with an osteoid osteoma (OO) of the 6th thoracic vertebra. The patient was treated conservatively with non-steroidal anti-inflammatory drugs (NSAIDs). Over eight months of clinical and radiological surveillance, she became entirely asymptomatic and demonstrated complete resolution of the scoliotic curve. The CT and MRI features of the osteoid osteoma during the period of surveillance are presented and are correlated with the corresponding clinical features.     

Osteoid osteoma of the second metatarsal bone diagnosed on MRI: A case report and literature review

Osteoid osteoma is a relatively common benign bone tumor that is most frequently seen on the appendicular skeleton in adolescents and young adults. Here we present the case of a 14-year-old boy presenting with a 10 month history of pain in his left foot which had been misdiagnosed as stress fracture due to its unusual clinical presentation. Magnetic resonance imaging of the left foot revealed a bone lesion with typical features of the osteoid osteoma on the distal part of the second metatarsal bone. The lesion was surgically removed and the diagnosis of osteoid osteoma was confirmed by post-surgical histopathologic examination of the resected section. The patient reported a substantial relief in his pain 4 weeks following the surgical operation.     

MR imaging-guided laser ablation of osteoid osteomas with use of optical instrument guidance at 0.23 T

The purpose of this study was to determine the feasibility and features of low-field MR imaging in performing interstitial laser ablation of osteoid osteomas. Between September 2001 and April 2002, five consecutive patients with clinical and imaging findings suggesting osteoid osteoma and referred for removal of osteoid osteoma were treated with interstitial laser treatment. A low-field open-configuration MRI scanner (0.23 T, Outlook Proview, Philips Medical Systems, Finland) with optical instrument guidance hardware and software was used. Laser device used was of ND-Yag type (Fibertom medilas, Dornier Medizin Technik, Germany). A bare laser fiber (Dornier Medizin Technik, Germany) with a diameter of 400 μm was used. Completely balanced steady-state (CBASS; true fast imaging with steady precession) imaging was used for lesion localization, instrument guidance, and thermal monitoring. A 14-G (Cook Medical, USA) bone biopsy drill was used for initial approach. Laser treatment was conducted through the biopsy canal. All the lesions were successfully localized, targeted, and treated under MRI guidance. All the patients were symptom free 3 weeks and 3 months after the treatment. There was one recurrence reported during follow-up (6 months). The MRI-guided percutaneous interstitial laser ablation of osteoid osteomas seems to be a feasible treatment mode.     

Discrete synchronous multifocal osteoid osteoma of the humerus

 A 24-year-old patient is described who had a 4-year history of pain in the right upper arm, with distinct night pain, that responded to salicylates. From the findings on conventional radiography, bone scintigraphy and MRI a multifocal osteoid osteoma was suspected, with one focus in the cancellous region of the greater tuberosity and a second cortical focus at the proximal humeral diaphysis. The resection ’’en bloc’’ of both tumors and histological examination confirmed the diagnosis. The patient was painfree after the curative resection of the two osteoid osteomas. Osteoid osteoma is a frequently found benign bone tumor, accounting for approximately 11% of cases. In rare cases a multicentric occurrence has been described. A possible occurrence of more than one osteoid osteoma in a single bone, not verified histologically, has been reported only three times in the literature. In patients with scintigraphic and radiographic findings of two foci, discrete synchronous multifocal osteoid osteomas should be suspected.     

Osteoid osteoma of the femoral neck mistaken as a synovial herniation pit

A 36-year-old man presented with 1 year of atraumatic left lateral thigh, groin, and hip pain, and imaging consistent with the diagnosis of femoroacetabular impingement and a labral tear. Imaging concurrently demonstrated a synovial herniation pit. The patient underwent hip arthroscopy, which included femoroplasty, acetabuloplasty, labral debridement, and synovectomy. His pain persisted and further workup confirmed an osteoid osteoma that was mimicking a synovial herniation pit. The osteoid osteoma was treated with radiofrequency ablation. At 18 months follow-up, the patient reported complete resolution of his symptoms. We present the case to highlight distinguishing imaging and clinical findings of these similar-appearing lesions. While neither condition is particularly rare individually, the misidentification of osteoid osteoma as a synovial herniation pit is a unique feature of this case that lead to the patient''s protracted clinical course.     

Unusual manifestation of vertebral osteoid osteoma: case report

We report the case of a 64 year-old man with a clinical history suggesting a low thoracic-cord involvement, in which an unexpected vertebral osteoid osteoma was discovered. The patient underwent MRI of the thoraco-lumbar spine, which included sagittal and axial T1-weighted images, and sagittal double-echo T2-weighted images. Subsequently, CT scan was carried out with 2-mm-thick axial sections, aimed at T10 vertebra. Magnetic resonance imaging disclosed an extra-axial mass at T10 level. Computed tomography scan suggested an osteoid osteoma of the tenth thoracic vertebra, involving the lamina with marked sclerosis and prevalently endocanalar extension. Histology following surgical resection confirmed the diagnosis. In the reported case CT scan provided the correct pre-operative diagnosis of osteoid osteoma despite its unusual clinical--anamnestic presentation. Magnetic resonance imaging was useful in establishing the relationship of the neoplasm with the spinal cord.     

Osteoid osteoma: percutaneous treatment with radiofrequency energy

PURPOSE: To report our experience with technical success, complications, and long-term clinical success of radiofrequency (RF) ablation of osteoid osteoma. MATERIALS AND METHODS: After needle biopsy, computed tomography (CT)-guided percutaneous RF ablation was performed with general or spinal anesthesia. With an RF electrode, the lesion was heated to 90 degrees C for 6 minutes. Patient age and sex, lesion size and location, biopsy results, and complications were recorded. Clinical success was assessed at a minimum of 2 years after the procedure. Significance of patient age and sex and lesion location and size as a predictor of biopsy result was tested by means of chi2 analysis. In addition, effects of patient age and sex, lesion location and size, and biopsy results on clinical success were tested with the Fisher exact test. RESULTS: During an 11-year period, 263 patients who were suspected of having osteoid osteoma underwent 271 ablation procedures. All procedures were technically successful. There were two anesthesia-related complications (aspiration, cardiac arrest) and two minor procedure-related complications (cellulitis, sympathetic dystrophy). Results at biopsy were positive in 73% (197 of 271 biopsies). Two-year follow-up data were available for 126 procedures. The other procedures had been performed more recently or the patients could not be contacted. There was complete relief of symptoms after 112 of the 126 procedures (89%). For procedures performed as the initial treatment, the success rate was 91% (107 of 117 procedures). Procedures for recurrent lesions had a significantly lower success rate (six of 10 procedures [60%], P <.001). Clinical outcome was not dependent on biopsy result, patient age or sex, or lesion size or location. CONCLUSION: CT-guided percutaneous RF ablation of osteoid osteoma is a safe and effective technique.