Outcome of Ct-Guided Radiofrequency Ablations of Osteoid-Osteoma in Growing Children
Background: Osteoid Osteoma (OO) is a relatively common benign bone tumor causing severe pain and debilitation. Historically it was surgically ostectomized en-block. Growth plate, articular cartilage and cortical strength where all threatened by this procedure. CT-RFA allows minimally invasive management while reducing these risks. Indications and outcome in adults are well-described, but guideline for pediatric management of OO is limited.
Methods: We retrospectively collected data regarding all pediatric/adolescent patients with OO that were managed in a single center between 2010 and 2016.
Results Forty two pediatric patients (34%) were included (mean age 11, range 2-16 years, 11 girls). Duration of symptoms ranged between 2-60 (median 9) months. Diagnostic modalities included X-ray in all cases, bone scan in 33(80%), CT in 40(98%), MRI in 28(68%). None of them had biopsy prior to intervention. Lesions were mostly in the femur (24, 54%). Fifteen (36%) cases were intra-articular, and 1 was juxta-physeal. All patients were managed on a day-care basis. Histology confirmed the diagnosis of OO in 19 cases (45%) and was inconclusive in all others. Pain subsided within 1-90 (median 2.5) days. Recurrent pain was observed in 4 cases, 1 underwent successful re-ablation, and all are currently asymptomatic. Wound infection was seen in 1 case, transient drop foot in 1 and limited knee extension in 1, all resolved. Long term imaging was not performed unless clinically indicated. Growth or articular changes were not found in any case. No fractures occurred.
Discussion & Conclusions: CT-RFA, performed with general anesthesia is safe and efficacious for management of OO children. Complications are minor and transient. Modern imaging modalities allow accurate diagnosis and localization prior/during the ablation thus histologic validation is not as pivotal as it was before. Specific pediatric considerations (juxta physeal and juxta-articular locations) may be safely accomplished by the experienced surgeon.