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  • Title: Percutaneous CT-guided curettage of osteoid osteoma with histological confirmation: a retrospective study and review of the literature.
    Author: Fenichel I, Garniack A, Morag B, Palti R, Salai M.
    Journal: Int Orthop; 2006 Apr; 30(2):139-42. PubMed ID: 16474938.
    Abstract:
    Osteoid osteoma is a benign bone tumour usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal), which can be alleviated by salicylates. Treatment consists of surgical excision 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 could be associated with some rates of both failure and complication. There is growing evidence to suggest that percutaneous CT-guided removal or destruction of the nidus is a good alternative and it is indeed gaining worldwide popularity. We present a series of 18 consecutive patients with osteoid osteoma of the pelvis, femur, and tibia, treated percutaneously under CT guidance. Removal of the nidus was performed using a 4.5-mm cannulated drill and a cannulated curette of our own design. Tissue samples for histological evaluation were obtained in the same way. The mean follow-up time was 29 months. Sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful (primary and secondary success rates 88 and 100% respectively). The diagnosis was histologically confirmed in 14 cases out of 18 (77%). In four cases no histological confirmation of osteoid osteoma could be achieved. There were only two minor complications, one case of femoral neuropraxia and one case of skin abrasion. Percutaneous CT-guided removal seems to be efficient and safe for the treatment of osteoid osteoma. The use of a cannulated drill and a cannulated curette facilitates efficient removal of the tumour and procurement of tissue for diagnosis. L’ostéome ostéoïde est une tumeur bénigne survenant chez le sujet jeune (10–30 ans), se manifestant par des douleurs intenses, typiquement nocturnes calmées par les salicylés. Classiquement la chirurgie était réalisée à ciel ouvert et le nidus retiré avec un bloc osseux. Les éléments convergent pour préférer un abord percutané, détruisant ou enlevant le nidus, guidé par scanner. Nous présentons une série de 18 cas consécutifs d’ostéomes ostéoïdes du bassin du fémur et du tibia traités de cette façon en utilisant une mèche canulée de 4,5 mm et une curette canulée, avec prélèvements à visée histologique. Le délai moyen de suivi est de 29 mois. Seize patients furent traités initialement et le procédé fut répété chez 2 patients (avec un taux de succés primaire de 88% et secondaire de 100%). Le diagnostic a été confirmé histologiquement 14 fois sur les 18. Il n’y a eu que 2 complications mineures (neurapraxie crurale et érosion cutanée). En conclusion, l’ablation de l’ostéome ostéoïde par voie percutanée sous contrôle scanner est un traitement efficace. L’utilisation d’un matériel spécial facilite le traitement et l’obtention d’un fragment pour biopsie.
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