Benign osteoid osteoma

Radiofrequency ablation in the treatment of benign osteoid osteoma causing severe pain is a well known and clinically accepted indication and has replaced open surgery due to its less invasive character and higher success rate regarding clinical symptoms (Woertler et al. 2001). 

In their series of 12 adult patients with a single painful osteolytic metastasis, Callstrom et al. (2002) showed onascale of 1 to 10,mean worst pain decreased from 8.4 to 3.1 after treatment. Osteoid osteomas are well suited to RF ablation because they are small, benign, and have finite growth. Approximately 90% of patients with osteoid osteoma are permanently cured after a single treatment. In such patients, percutaneous ablation with radiofrequency is essentially equivalent to operative excision (Rosenthal et al. 1998). 

Osteoid osteoma is a benign lesion of the skeleton consisting of a central area of osteoplastic tissue (nidus) surrounded by a zone of reactive sclerotic bone (Figs. 6.4, 6.5, 6.6). The main symptom is pain, which is most severe at night and can often be relieved by aspirin and other nonsteroidal antiinflammatory drugs (Pinto et al. 2002). Most of... 

The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1 2000. 

In this setting, thermal ablation will be mainly a symptomatic, supportive (palliative) therapy, which can also be applied in conjunction with other therapies such as resection, radiotherapy or chemotherapy. In contrast to the treatment of malignant tumours, local thermal ablation is considered the method of choice in treatment of symptomatic benign bone tumours such as osteoid osteomas. 

Osteoid osteoma is a benign lesion of unknown origin. Typically, the lesion is formed by a central, vascularized nidus surrounded by a reactive sclerosis with a diameter of less than 2 cm, in contrast to the larger osteoblastoma. Because of the central nidus, a vascular malformation is discussed as being the origin of these lesions. Most of the tumours occur in the first three decades of life, with a male predominance (maleifemale = 2 1). Osteoid osteomas can be found in any bone of the body however, the spine is the preferred localization, where 50% of all osteoid osteomas occur in the lumbar spine, and 75% of the tumours in the pedicles of the vertebrae. Other typical localizations are femur, radius, knee and ankle. 

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