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

Cheng, Edward Y; Naranje, Sameer M

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.