Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance.
OBJECTIVE
To evaluate interstitial laser photocoagulation (a minimally invasive percutaneous technique of thermal destruction of deep-seated tumors, with low-power laser energy) in local destruction of osteoid osteoma, with computed tomographic (CT) guidance.


METHODS
Fifteen patients (age range, 8-48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high-power semiconductor diode laser (805 nm) with a 400-microm optical fiber was used. The fiber was introduced into the nidus through an 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1,000 J) were obtained.


RESULTS
Fourteen patients had complete pain relief, which was apparent within 24 hours in eight patients. One patient had recurrence of pain after 6 weeks. The remaining nidus was treated a second time, with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. Daily activities were not restricted after the intervention. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 4-6 months after the procedure.


CONCLUSIONS
Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.
Gangi
A
A
Department of Radiology, University Hospital of Strasbourg, France.
Dietemann
J L
JL
Gasser
B
B
Mortazavi
R
R
Brunner
P
P
Mourou
M Y
MY
Dosch
J C
JC
Durckel
J
J
Marescaux
J
J
Roy
C
C
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D004582:Electronics, Medical / Q000295:instrumentation; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D005336:Fiber Optic Technology / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009339:Needles; D009364:Neoplasm Recurrence, Local; D055100:Optical Fibers; D010017:Osteoma, Osteoid / Q000601:surgery*; D010146:Pain / Q000601:surgery; D015641:Radiography, Interventional; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology; D012598:Sclerosis; D012666:Semiconductors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome