Cryoablation of osteoid osteomas: Is it a valid treatment option?

Abstract

Background: Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology. The selected method for its treatment is percutaneous radiofrequency ablation. However, percutaneous cryoablation is an alternative method with certain advantages.

Aim: To evaluate percutaneous computed tomography (CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults.

Methods: A total of 25 patients were treated with percutaneous CT- guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution. All patients were above 14-years-old (mean age, 24-years-old), and all procedures were performed under local anesthesia. Of the 25 patients, 8 were female and 17 were male. Tumor sites included the femur (n = 9), medial malleolus (n = 4), sacral ala (n = 4), facets (n = 4), humerus (n = 3), and tibia (n = 1). One cryoprobe was used in each procedure and, when possible, the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus. All necessary thermal protective techniques were used depending on the anatomical structure at risk.

Results: All patients treated had complete response (100% clinical success rate) starting on the day of the procedure. Technical success was achieved in all cases. Visual analog scale (VAS) scores at 1 year were 0, compared to a mean VAS score of 8.5 ± 1 (SD) before the procedure. No recurrences were reported at the 1-year follow-up and no complications were observed. In 11/25 cases, an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort. All patients were discharged from the hospital on the same day as the procedure.

Conclusion: Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results. Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.

Keywords: Bone tumors; Computed tomography guidance; Cryoablation; Interventional radiology; Orthopedics; Osteoid osteoma.

Figure 1

Eighteen-year-old female-osteoid osteoma of the medial malleolus (tibia). A: Coronal T2WI image reveals 1 cm lesion of the medial malleous in close proximity to the skin and the ankle joint; B: Computed tomography image demonstrates a lytic lesion with reactive sclerosis. The lesion was biopsied and confirmed as an osteoid osteoma; C: Cryoablation procedure: Cryoprobe placement inside the nidus and a spinal needle in the joint for active warming during the procedure. Skin was hydrodissected with a mixture of saline and local anesthetic and a warm glove was applied for protection.

Figure 2

Twenty-four-year-old male-osteoid osteoma of the L4-L5 facet joint. A: Computed tomography axial image L4-L5 facet joint osteoid osteoma; B: Placement of the cryoprobe at an extraosseous position; C: Placement of a thermocouple near the nerve root for temperature monitoring. Spinal needle at the same level for epidural dissection and active warming; D: Iceball visualization as hypodense area covering the entire lesion.

Figure 3

Seventeen-year-old male-humerus bone multiple osteoid osteomas. A: Computed tomography thick slice and magnetic resonance imaging showing three radiolucent lesions in head, epiphysis and diaphysis of right humerus bone with periosteal edema; B: Visualization of the three cryoprobes. Two of them were placed in extraosseous positions and one of them was placed in an intraosseous position; C: Hydrodissection of the axillary nerve with thermocouple for temperature monitoring, protection and active warming.

Figure 4

Twenty-three-year-old male-tibia ostoid osteoma. A: Axial computed tomography image of a tibia osteoid osteoma; B: Placement of the cryoprobe at an extraosseous position parallel to the cortex; C: Hypodense ice covering the whole lesion.

Figure 5

One month after cryoablation procedure of osteoid osteoma of humerus bone reduction of the periosteal reaction.