Is Percutaneous Radiofrequency Ablation Effective Treatment for Osteoid Osteoma in Children?

The objective of a recent study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma in children.
The study has concluded that percutaneous CT-guided radiofrequency ablation is an effective and safe procedure for treatment of osteoid osteoma in children.

Participants
Over a 3-year period, children who were referred to a tertiary care hospital for percutaneous CT-guided RF ablation of osteoid osteoma were recruited for this study.

Methodology
Required clinical criteria for treatment included presence of pain for at least 6 months that was worse at night and relieved with oral anti-inflammatories. Patients undergoing treatment required an imaging protocol including plain radiography, triple-phase bone scintigraphy, and CT to confirm the radiologic criteria of osteoid osteoma.

All patients were placed under general anesthesia. Thin-section CT guidance was used. An 8-step technique, which was previously described by Vanderschueren in AJR in 2002, was used.

Patients were followed up at 1 and 3 months in the clinic and were contacted by telephone at 6, 12, and 24 months for follow-up regarding complications or pain recurrence.

Technical success was defined as ability to localize the radiolucent nidus and electrode placement under CT guidance with ablation performed for the desired period. Clinical success was defined as complete relief of symptoms within 1 month of the procedure.

Results
23 patients were included in the study. Ages ranged from 3.5 to 16.0 years, with a mean age of 11.0 years. Technical success was achieved in 91.3% of patients. Mean time of ablation was 4.5 minutes, with total procedure duration averaging 120.0 minutes. Technical failure in 2 children was attributed to inadequate localization in 1 and hyperthermia in another.

Primary clinical success rate was 78.2%; 1 patient returning for a repeat procedure resulted in a total secondary clinical success rate of 82.6%. Mean length of in-hospital stay was 2.4 days. Only minor complications were observed including wound infection and skin burn, which were treated with simple dressing with no residual scarring.

Conclusions
Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children.

Although high technical and clinical success rates are reported, when compared to adults undergoing a similar procedure, success rates are lower overall. Literature reviews reveal success rates in populations with a wider age range predominantly above 90%.

Reviewer’s Comments
The study hints at the possibility of older children generally having higher technical and clinical success rates than younger children. Overall success rates are good, however. Like any procedure, success rates will likely correlate well with the experience of the treatment team.

Author: Basil Hubbi, MD

Reference:

Donkol RH, Al-Nammi A. Moghazi K. Efficacy of Percutaneous Radiofrequency Ablation of Osteoid Osteoma in Children. Pediatr Radiol; 2008; 38 (February): 180-185