Radiofrequency Ablation of Osteoid Osteoma with Use of Intraoperative Three-Dimensional Imaging and Surgical Navigation.

INTRODUCTION

During the performance of radiofrequency ablation of osteoid osteomas, the use of intraoperative cone-beam computed tomography (CT) imaging with surgical navigation lowers radiation exposure while allowing real-time targeting of the nidus.

STEP 1 PREOPERATIVE PLANNING: Review all images to confirm a high level of confidence in the radiographic diagnosis.

STEP 2 PATIENT POSITIONING AND SETUP: Be sure to position and set up properly.

STEP 3 PLACEMENT OF TRACKING OPTICAL ARRAY: Attach the optical array to the target bone.

STEP 4 O-ARM SETUP INITIAL CT IMAGING FOR SURGICAL NAVIGATION AND REMOTE MOUSE REGISTRATION: Set up the intraoperative CT (O-Arm) machine and acquire the initial images for surgical navigation.

STEP 5 CT DATA INTERPRETATION AND APPROACH PLANNING: Analyze the initial images, rotated or positioned as necessary, to allow you to proceed with the planned direction and angle of approach to the nidus.

STEP 6 SURGICAL NAVIGATION SETUP: Register the surgical instruments with the surgical navigation unit.

STEP 7 NIDUS LOCALIZATION AND KIRSCHNER WIRE INSERTION: Target the nidus and then insert the Kirschner wire into its center.

STEP 8 EXCHANGING KIRSCHNER WIRE FOR A RADIOFREQUENCY PROBE: Once the accuracy of the Kirschner wire placement is confirmed, exchange it for the radiofrequency probe and perform a CT scan to confirm proper probe placement.

STEP 9 CONFIRMATION OF RFA PROBE PLACEMENT: Perform a CT scan to confirm proper placement of the probe within the center of the nidus.

STEP 10 ACTIVATION OF THE RADIOFREQUENCY PROBE AND CLOSURE: Perform the radiofrequency treatment to ablate the cells within the nidus.

RESULTS

We conducted a study of three different techniques of radiofrequency ablation.IndicationsContraindicationsPitfalls & Challenges.