Image-guided laser ablation of osteoid osteoma in pediatric patients.
BACKGROUND
We aimed to evaluate the effectiveness of image-guided laser ablation for the treatment of osteoid osteomas in pediatric patients.


METHODS
From June 1994 to June 2006, 68 patients aged 3 to 18 years (mean age, 12.1 +/- 4.2 years) with a diagnosis of osteoid osteoma underwent laser ablation in our department. Among them, 3 patients had prior unsuccessful attempt of surgical resection. Procedures were performed under spinal or general anesthesia with combined computed tomographic and fluoroscopic guidance. An 18-gauge needle was placed in the nidus after bone drilling when required, and an optical fiber was inserted through it. An average energy of 1200 J was delivered using an infrared diode laser generator. Patients were discharged the next day and followed up with assessment of pain, medication intakes, and potential complications. Clinical success was defined by complete pain relief without need for medication intake.


RESULTS
Technical success was achieved in all but 1 of our first patients, which was subsequently treated by percutaneous resection. Overall clinical success was 98%. Primary clinical success was obtained in 60 patients (88%). In 7 patients, recurrence of symptoms at 4 to 27 months from the initial procedure was managed by repeat laser ablation, resulting in secondary success (10%). No complications related to the procedure were observed. Follow-up ranged 16 to 146 months (mean, 83 months).


CONCLUSIONS
Currently, image-guided laser ablation is a safe and effective procedure that can be proposed as the mainstay treatment of osteoid osteomas in pediatrics.


METHODS
Therapeutic case series study level IV.
Moser
Thomas
T
Department of Radiology, University Hospital, 1 Place de l'Hôpital, Strasbourg, France. thomas.moser@chru-strasbourg.fr
Giacomelli
Marie-Christine
MC
Clavert
Jean-Michel
JM
Buy
Xavier
X
Dietemann
Jean-Louis
JL
Gangi
Afshin
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010017:Osteoma, Osteoid / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome