CT-Assisted Percutaneous Removal of an Osteoid Osteoma

Abstract

Objective

Removal of the nidus of an osteoid osteoma through a minimally invasive procedure to eliminate pain and to restore function. Histologic examination of biopsy material.

Indications

Osteoid osteomas irrespective of localization as long as they can be directly reached percutaneously.

Contraindications

Nerves, vessels or other important structures precluding a direct percutaneous approach.

Surgical Technique

Placement of guide wire in soft tissues. CT check. Stab incision. Insertion of threaded Kirschner wire into bone 1 cm parallel to the projected approach. Advancement of Kirschner wire mounted on a drill under CT control up to the nidus.

Insertion of a cannulated drill bit over the Kirschner wire and drilling of cortex and subcortical bone.

A special trephine mounted on a hand-held Jacob’s chuck is advanced into the nidus under CT control.

Removal of the Kirschner wire and change for a drilling system with extraction forceps.

Overdrilling of the nidus. Advancement of extraction forceps and extraction of nidus.

If needed, removal of remaining material with curette or rongeur.

Final CT check.

Results

Between March 9, 1998 and January 25, 2000 we operated five women and twelve men, average age 22 (11–57) years. Femoral neck, tibia and femur were mostly involved. All patients were pain-free and without limitation of function immediately after surgery and at time of follow-up done at an average of 8.4 (1–22) months. No important complications. Through a technical error the nidus was lost in the soft tissues together with the extraction device. Only the metal part could be retrieved, subsequent encapsulation of the nidus in the soft tissues without causing symptoms. A superficial wound healing disturbance was noted in another patient.