RF ablation of osteoid osteomas

Radiofrequency ablation (RFA) is a minimally invasive procedure used to treat osteoid osteomas, which are benign but painful bone tumours commonly found in children and young adults. The procedure involves using radiofrequency energy to heat and destroy the tumour tissue. 

Indications

RFA is indicated for patients with:

1. Osteoid Osteomas: Small, benign bone tumours that cause significant pain, often worsening at night and responding poorly to conventional pain relief methods (Click here to read more on Osteoid Osteoma)
2. Refractory Pain: Pain that does not adequately respond to nonsteroidal anti-inflammatory drugs (NSAIDs) or other conservative treatments.
3. Location Accessibility: Tumours that are accessible to RFA and not located in critical areas where the procedure might cause damage to surrounding tissues or structures.

Procedure

1. Pre-procedure Planning:
   • Imaging Studies: CT scans or MRIs are used to precisely locate the tumor and plan the approach.
   • Patient Evaluation: Assessment of overall health and suitability for the procedure.
2. Anesthesia:
   • The procedure is typically performed under general anesthesia or conscious sedation, depending on the patient’s age, tumor location, and preference.
3. Positioning:
   • The patient is positioned on the procedure table to allow easy access to the tumor site.
4. Needle Insertion:
   • Using CT or fluoroscopic guidance, a specialised needle or probe is inserted through the skin and directed precisely into the centre of the osteoid osteoma.
5. Radiofrequency Ablation:
   • Once the needle is in place, radiofrequency energy is delivered through the probe, generating heat (up to 90-100°C) that destroys the tumour tissue.
   • The ablation process typically takes about 6-8 minutes, and the surrounding bone tissue helps contain the heat, minimising damage to adjacent structures.
6. Post-procedure Imaging:
   • After ablation, imaging is performed to confirm the correct placement of the probe and the successful ablation of the tumour.

Benefits

• Effective Pain Relief: RFA provides rapid and significant pain relief, often within a few days after the procedure.
• Minimally Invasive: The procedure is less invasive than open surgery, with smaller incisions and reduced recovery time.
• Quick Recovery: Most patients can resume normal activities within a few days.

Risks and Considerations

• Infection: Risk of infection at the insertion site, though this is rare.
• Nerve or Tissue Damage: Potential risk of damage to nearby nerves or tissues, particularly if the tumour is near critical structures.
• Incomplete Ablation: There is a small chance that the tumour may not be completely ablated, necessitating a repeat procedure.
• Recurrence: Although rare, there is a possibility of the osteoid osteoma recurring after RFA.

Conclusion

Radiofrequency ablation is an effective and minimally invasive treatment option for osteoid osteomas, providing rapid pain relief and a quick recovery. By using real-time imaging guidance, RFA ensures precise targeting of the tumor, minimizing damage to surrounding tissues and reducing the risks associated with more invasive surgical procedures. This makes it a preferred treatment choice for patients suffering from the debilitating pain of osteoid osteomas.