MANAGEMENT OF OSTEOID OSTEOMA

MEDICAL MANAGEMENT:

As discussed earlier, there may be delay between onset of symptoms and initiation of diagnosis of osteoid osteoma. Initial therapy of choice in most cases is medical. Salicylic acid is often helpful to give sypmptomic and lasting relief from night pain. It has been suggested that prostaglandins play important role in the pathogenesis of osteoid osteoma as large amount of prostaglandins were found in the histologic specimen of excised lesions. This is the reason behind immediate pain relief from prostaglandin synthesis inhibitors like aspirin. If there is no relief with medical therapies, then others treatment options should be sought.

SURGICAL MANAGEMENT:

Definitive cure can only be achieved with surgical excision of the lesion. But there are hurdles in complete removal of lesion and exact localization is one of the most important hurdles. Preoperative localization can be achieved with x-rays or computerized tomography. If there is still any problem in the localization, then there are many intraoperative options available for precisely localizing the tumor.

One of such options is use of x-ray during surgery. Another method is use of scintillating needles which are easy to use and are considered the best method to localize the lesion. Precise localization means less bone excision, excellent cure with less chances of recurrence and complete removal of nidus in the excised specimen. The excised sample is then sent to the laboratory for histological examination to look for presence of nidus. If nidus is not found, second attempt is made to remove it properly.

Sometimes it is difficult to completely remove intra-articular lesions in which case, other treatment options are adopted.

RADIOFREQUENCY ABLATION:

In this method, computerized tomographic guidance is taken to insert a needle which will ablate the tumor with the help of radiofrequency waves. This method has excellent results but needs expertise of the part of surgeon.

OTHERS MANAGEMENT OPTIONS:

Computerized tomography percutaneous removal can be attempted in some cases. Sometimes deroofing and curettage is contemplated.

A new technique in this context is the introduction of magnetic resonance guided focused ultrasonography for the excision of tumor with some promising results.