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

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.

COMPARISON OF CT-GUIDED LESS INVASIVE SURGERIES WITH WIDE SURGICAL EXCISION IN TREATMENT OF OSTEOID OSTEOMAS

Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.

Gardner's syndrome:Genetic testing and colonoscopy are indicated in adolescents and young adults with cranial osteomas:A case report

We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative procto-colectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.

Intradural osteomas:Report of two cases

BACKGROUND Intradural osteoma is very rarely located in the subdural or subarachnoid space.Unfortunately,intradural osteoma lacks specificity in clinical manifestations and imaging features and there is currently no consensus on its diagnosis method or treatment strategy.Moreover,the pathogenesis of osteoma without skull structure involvement remains unclear.CASE SUMMARY We describe two cases of intradural osteomas located in the subdural and subarachnoid spaces,respectively.The first case involved a 47-year-old woman who presented with a 3-year history of intermittent headache and dizziness.Intraoperatively,a bony hard mass was found in the left frontal area,attached to the inner surface of the dura mater and compressing the underlying arachnoid membrane and brain.The second case involved a 56-year-old woman who had an intracranial high-density lesion isolated under the right greater wing of the sphenoid.Intraoperatively,an arachnoid-covered bony tumor was found in the sylvian fissure.The pathological diagnosis for both patients was osteoma.CONCLUSION Surgery and pathological examination are required for diagnosis of intradural osteomas,and craniotomy is a safe and effective treatment.

A New Technique to Remove Accurately Osteoid Osteomas Using Gamma Probe

Study design: Description of a technique through a case-series. Objective: To promote a technique by using a gamma probe that asses intraoperatively the adequacy of the lesion curettage through a minimal invasive procedure. Methods: Reviewing the technique steps through 4 cases of osteoid osteoma surgical removal. Results: Four patients diagnosed with osteoid osteoma and moved to surgical removal. During the operation, excision of the tumour was assessed by a gamma probe, avoiding leaving residual lesion in the field. Operating time was not prolonged, so as the cost of the operation was not increased. Conclusions: Surgical excision of osteoid osteoma in spine region is still the gold standard method. Avoiding recurrence of the lesion is important. The use of gamma probe is an effective and economic solution.

外耳道骨瘤临床分析

外耳道骨瘤患者临床少见，肿瘤生长缓慢，症状表现不典型，部分为体检时发现，病因尚不明确。我科自2004年1月～2015年6月共收治外耳道骨瘤患者17例，经手术治疗效果良好。

颞骨巨大乳突部骨瘤1例

1临床资料 患者,女,51岁。因右耳后肿块20年伴耳后胀感半年,于2007-01-12入院。该患者于20年前无意中发现右耳后蚕豆大小硬性肿块,渐进增大但未就诊,近半年肿块增大明显至核桃大小并伴有局部胀感,进而入院手术治疗。查体：右耳后乳突部扪及4cm×3cm×3cm,硬性肿块,边界清、不活动,无压痛,耳道畅,听力正常。颞骨CT检查示：右颞皮下肿块样高密度影,呈伞状突起,与颞骨紧密相连（图1）。

Middle ear osteoma causing Eustachian tube obstruction:A case report and literature review

Middle ear osteoma is an extremely rare benign tumor of the middle ear.Due to its very slow growth rate and benign nature,osteoma of the middle ear can be found incidentally without causing any symptoms.The most common clinical signs are conductive hearing loss,the sense of fullness in the ear,tinnitus,and otorrhea.Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss.When the mass becomes very large,and symptoms caused by the tumor increase,treatment also becomes difficult.In this paper,we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube.We also present a review of the pertinent literature.

CT-guided radiofrequency ablation of osteoid osteoma in the long bones of the lower extremity

AIM:To present our initial experience with computed tomography guided radiofrequency ablation(RFA) of osteoid osteoma(OO) in our institution.METHODS:RFA was performed on eight patients(5 males and 3 females) with clinically and radiologically diagnosed OO(femoral neck,n = 4;femoral diaphysis,n = 2;tibial diaphysis,n = 1;fibular diaphysis,n = 1).Ablation was performed using an electrode with a 10-mm exposed tip for a total of 4-6 min at a targeted temperature of 90 degrees Celsius.No cooling system was used.The intervention was accepted as technically successful if the tip of the electrode could be placed within the center of the nidus.We defined clinical success as a disappearance within 2 wk after treatment of symptoms that had manifested at presentation.RESULTS:All procedures were technically successful.No major or immediate complications were observed.Clinical success was achieved in six of eight patients in the first procedure.A second procedure was performed for two patients who had recurrent or continued pain,and one of these cases was successfully treated.The overall rate of success was 87.5%(7/8).No complication was observed.CONCLUSION:Our preliminary results indicate a favorable success rate and no complications and are compatible with the previous reports of RFA of OO.

Arthroscopic removal as an effective treatment option for intraarticular osteoid osteoma of the knee

BACKGROUND Intra-articular osteoid osteoma(iaOO)can be found in 5.2%up to 10%of cases.They may cause non-specific symptoms,mimicking degenerative or traumatic pathologies.If iaOO is left untreated,it may lead to severe muscle atrophy,tenderness,swelling,and limited range of motion.Therefore,surgical treatment is recommended.The main goal of surgical treatment is complete removal or destruction of iaOO.AIM To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.METHODS Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed.All patients had a diagnosis of iaOO confirmed by histopathologic analysis.Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made.All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.RESULTS The average age of patients included in our study was 23.2(range 16-37)years.The average duration of the symptoms prior to surgery was 14.2(range 6-24)months.All of the patients had persistent knee pain.Three patients reported worsening of pain during the night,while two reported worsening of pain during activity.Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs(NSAIDs),while one patient reported partial alleviation of pain on NSAIDs.No intraoperative complications were noted,and the postoperative period was uneventful in all patients.The patients reported immediate pain relief in the postoperative period.No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo.The literature review revealed 14 cases with an average age of 27.6(range 16-48)years and onset of symptoms 27.7(range 6-108)months prior to surgery,with recurrence of the disease noted in a single case.CONCLUSION Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive,thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.

Bilateral choroidal osteoma with unilateral polypoidal choroidal vasculopathy treated with conbercept

Dear Editor,Chorodial osteoma(CO) is a rare choroidal tumor characterized by the presence of mature bone tissue predominantly in the juxtapapillary or macularregion.CO mostly affects young healthy females in the second or third decades of life.It is unilateral in approximately 80%of cases[1],as patients have no obvious visual symptoms during the early stage of CO,and the growth of CO is slow.CO patients usually visit the eye clinic during the later stages of CO and have poor vision.Gradual decline in vision in CO patients is related to changes in retinal pigment epithelium(RPE)and photoreceptor atrophy.Choroidal neovascularization(CNV)and the resultant subretinal fluid and hemorrhage are the most frequent causes of sudden vision loss in CO[2].We report a rare case of bilateral CO with unilateral polypoidal choroidal vasculopathy(PCV)in a middle-aged male.

3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma

Choroidal osteoma (CO) is a rare, ossifying benign tumor originated in the choroid that typically occurs in otherwise healthy young women (1,2). It is characterized by a yellowish, well demarcated lesion in the juxtapapillary or macular area. The diagnosis is clinical and can be confirmed with the use of fluorescein or indocyanine angiography, optical coherence tomography, computed tomography or magnetic resonance imaging. Choroidal neovascularization or subretinal fluid, the main causes for vision loss, can be treated with laser therapy, photodynamic therapy or intravitreal antivascular endothelial growth factor therapy. We present a case of choroidal osteoma, showing the role of the high resolution 3D spiral computed tomography.

Osteoid osteoma of the elbow mimicking hemophilic arthropathy

A case of osteoid osteoma of the elbow in a patient with hemophilia A is described. This male patient presented with chronic and nocturnal pain of the left elbow which was alleviated with acetaminophen. Besides pain, he also complained of stiffness. Before these complaints, he had recurrent bleedings in the elbow because of hemophilia. A delayed diagnosis of osteoid osteoma in the proximal part of the left ulna was established by a bone scan and a multislice spiral computed tomography(CT) scan. The lesion was surgically removed under CT-guidance. The histopathological analyses did not show specific features of osteoid osteoma. Two months after the operation, the complaints decreased and the range of motion of the left elbow improved. A diagnosis of osteoid osteoma of the elbow should be considered in young adult patients with persistent elbow pain and histological confirmation is not always necessary.

Intracortical chondroma of the metacarpal bone:A case report

BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on clinical imaging,it is difficult to differentiate between intracortical chondroma and osteoid osteoma.Therefore,pathological examination is usually required to establish a definite diagnosis,which is often carried out only after tumor removal.In this study,we describe a case of intracortical chondroma which developed in the metacarpal bone and demonstrate the utility of magnetic resonance imaging(MRI).CASE SUMMARY We present a case of a 40-year-old man with intracortical chondroma of the metacarpal bone who was strongly suspected of having a tumor,and it was confirmed using contrast-enhanced MRI and successfully treated with curettage.MRI performed before tumor removal revealed signal intensity similar to that of the nidus of an osteoid osteoma.However,no abnormal intensity was observed in the bone or soft tissues surrounding the tumor.Such abnormalities on images would indicate the presence of soft-tissue inflammation,which are characteristics of osteoid osteoma.Furthermore,contrast-enhanced imaging revealed no increased enhancement of the areas surrounding the tumor.This is the first report to describe the contrast-enhanced MRI features of intracortical chondroma.This may serve as a guide for clinicians when intracortical chondroma is suspected.CONCLUSION The contrast-enhanced MRI was useful for the differential diagnosis of intracortical chondroma.

Osteoma of mastoid process obstructing external auditory canal: A case report

Objective: To discuss the surgical treatment of recurrent osteoma of the mastoid process of the temporal bone, that obstructed external auditory canal causing unilateral conductive hearing loss. Setting: The study was carried out in ENT Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo. Design: Retrospective review of a clinical case. Patient, Intervention and Result: We treated surgically with success a 14-year-old boy with osteoma of mastoid process, obstructing the external auditory canal of the left ear and causing conductive hearing loss. Axial and coronal computed tomography scans revealed an compact bone lesion that obstructed the canal. Complete removal of the lesion was achieved by a retroauricular approach. Conclusion: In order to achieve complete removal of the osteoma, drilling of the lesion must be performed not through the tumor, but around the osteoma, in the surrounding bone tissue.

Facial Asymmetry Caused by Mandibular Osteoma: Case Report

Osteoma is a benign tumor that often affects the maxillofacial region. It exhibits slow growth and remains asymptomatic for prolonged time and may cause facial asymmetry or functional disorders when it reaches vast proportions. When osteomalacia is diagnosed it is important to check about Gardner’s Syndrome because up to 90% of patients with this syndrome may present skeletal abnormalities and osteomas. The objective of this paper is to report a case of a 54-year-old woman that related an 8-year evolution of a volume increase in the face. Clinical examination showed facial asymmetry and presence of nodular lesion located in the left region of the mandibule, painless and hard on palpation. Panoramic radiography showed radiopaque image limited to the left mandibular body and angle, suggestive of osteoma. Gastrointestinal review was requested and discarded intestinal polyps and Gardner’s Syndrome. The patient was submitted to excisional biopsy and microscopic examination of the tumor that confirmed the diagnosis of osteoma. Osteoma needs special attention due to the possible association with malignant lesions intestine and also by psychological and functional problems, when it reaches great proportions.

Recurred forehead osteoma disseminated after previous osteoma excision:A case report

BACKGROUND Forehead osteoma is a commonly encountered benign facial bone tumor.Endoscopic excision of benign forehead masses is widely performed.Here,we report a rare case of recurrent forehead osteoma that disseminated after a previous osteoma excision.CASE SUMMARY A 54-year-old female patient had previously undergone endoscopic removal of a single forehead osteoma at 30 years of age.However,she had a recurrent osteoma around the same site and underwent another endoscopic resection at 40 years of age.During her first visit to our outpatient clinic,she presented with a cobblestone-like irregular surface on the forehead and a 3D facial bone computed tomography scan revealed a widely ragged surface of the inoculated osteoma on the outer table of the frontal bone.Under general anesthesia,we performed a radical complete excision of the disseminated osteoma through a bicoronal incision using an osteotome,chisel,mallet,and rasping.We hypothesized that the recurrence may have been caused by the inoculation of residual osteoma remnants from the previous procedure.Craniofacial surgeons should be cautious when removing osteoma particles,particularly when using an endoscopic approach.CONCLUSION To prevent recurrence,it is essential to conduct additional meticulous burring and a thorough inspection of the surface after copious irrigation.

A Case Report of Oseoid Osteoma in the Ulnar Cortex of the Distarl Radius Extending into the Distal Radioulnal Joint<br>—COX-2 Produced Prostaglandin E2 Possible Case of the Symptoms<br>

An 18-year-old girl presented with an osteoid osteoma in the ulnar side of the cortex of the distal radius extending into the distal radioulnar joint. The osteoid osteoma was removed from the distal radius at surgery. The patient’s symptoms were dramatically improved the day after surgery. A high concentration of prostaglandin E2 (PGE2) was seen in the joint and surrounding soft tissues, and cyclooxygenase-2 (COX-2) receptors were stained in the joint capsule and synovium inside the joint. This case report is the first to describe the concentration of PGE2 and stained COX-2 receptors in an osteoid osteoma in the ulnar cortex of the distal radius extending into the distal radioulnar joint.