Percutaneous CT guided excision of osteoid osteoma confirmed by tissue diagnosis

Introduction: osteoid osteoma is a benign bone tumor usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal) alleviated by salicylates. Treatment consists of surgically excising or destroying the nidus and it is curative. In the past, surgery was performed in an 'open' fashion and the nidus had to be removed with a bone block. This extensive type of surgery was associated with high rates of both failures and complications. There is growing evidence to suggest that percutaneous computed tomography (CT) guided excision of the nidus is a better alternative and it is indeed gaining worldwide popularity. Patients and Methods: we present a series of 18 patients with ostoid osteoma of the pelvis, femur and tibia, treated percutaneously under CT guidance. Tissue samples for histological evaluation were obtained by way of a specially designed self-manufactured canulated curette. Results: sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful. The diagnosis was histologically confirmed in 14 cases out of 18 (77%). There were only three minor complications and no recurrences. Conclusions: Percutaneous CT guided excision is indeed a simple, precise and safe way of treating osteoid osteoma. The use of a canulated curette facilitates obtainment of tissue for diagnosis especially when using a drill that is also canulated but not hollow. (C) 1999 Harcourt Publishers Ltd.