Advantages and disadvantages of methods of visualization in the surgical treatment of osteoid osteoma in children

Introduction. In cases of osteoid osteoma (OO) of small sizes, visualization of tumor is difficult. In Russia, surgical removal under the control of an electron-optical converter (EOP) is often chosen for the treatment of OO, and only a few centers use CT control. The aim of this work is to identify the advantages and disadvantages of intraoperative imaging for surgical removal of OO in children using EOP and CT with navigation. Materials and methods. Sixteen 5 to 18 years patients with a diagnosis of OO were treated. The patients were divided into 2 groups depending on the method of intraoperative imaging: group 1 — surgical removal of OO under the EOP control (n = 7), group 2 — removal under the control of CT with a navigation system (n = 6). Exclusion criterion: tumor location outside the upper third of the femur (n = 3). The following indicators were evaluated: radiation load over the entire treatment period, the volume of resection, and the presence of X-ray symptoms. Results. In patients from group 2 with removal under the control of CT with navigation for the entire period of treatment, the radia­tion load was 5.24 ± 1.19 mSv, while in children from group 1 — 3.69 ± 1.28 mSv. In 4 patients, the diagnosis was not made. In 13 patients, CT revealed a focus of lytic destruction with a peripheral rim of sclerosis. The volume of postoperative defect of the bone defect in patients of group 1 was 5548 ± 1694.2 mm3, and in patients of group 2 — 2131.57 ± 290.301 mm3. It is obvious CT with a navigation system to be a highly sensitive method of detecting a tumor, allows minimizing the volume of bone tissue to be removed and instrumentally confirming the removal of OO. Conclusion. Intraoperative CT with navigation has a number of advantages over EOP control due to the less volume of resection of healthy bone tissue, it becomes possible to obtain intraoperative confirmation of OO removal, without need for immobilization during the postoperative period.