INTERSTITIAL LASER PHOTOCOAGULATION OF OSTEOID OSTEOMAS WITH USE OF CT GUIDANCE

PURPOSE: 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 o steoma, with computed tomographic (CT) guidance. MATERIALS AND METHODS : Fifteen patients (age range, 8-48 years) with presumed osteoid osteo ma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high-power semiconductor diode laser (805 nm) with a 400- mu m optical fiber was used. The fiber was introduced into the nidus t hrough an 18-gauge needle. Around the fiber tip, well-defined coagulat ive necroses from 5 to 9 mm (energy delivery, 400-1,000 J) were obtain ed. RESULTS: Fourteen patients had complete pain relief, which was app arent within 24 hours in eight patients. One patient had recurrence of pain after 6 weeks. The remaining nidus was treated a second time, wi th complete relief Treatment was unsuccessful in one patient, and surg ical excision was performed. Daily activities were not restricted afte r 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 o f the nidus was observed 4-6 months after the procedure. CONCLUSION: P ercutaneous interstitial laser photocoagulation of osteoid osteoma see ms to be a promising, simple, precise, and minimally invasive alternat ive to traditional surgical and percutaneous ablations.