Efficacy, safety, and short-term follow-up results of CT-guided radiofrequency and microwave ablation in the treatment of Osteoid Osteoma

Introduction: The use of Computed Tomography-guided (CT-guided) percutaneous thermal ablation (PTA) techniques in the treatment of osteoid osteoma (OO) has been increasingly adopted worldwide. This study aims to evaluate the efficacy and safety of thermal ablation techniques in OO treatment, with a particular focus on short-term clinical success rates. Methods: A retrospective analysis was conducted on 19 patients who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) CT-guided in the Interventional Radiology Department of Pamukkale University Faculty of Medicine Hospital between October 2018 and December 2024. Data were obtained from hospital records. All procedures were performed under sedation by a single interventional radiologist, and follow-up evaluations were recorded on post-procedure day 1 and month 1. Visual Analog Scale (VAS) scores and lesion characteristics were reviewed from medical records. Technical success was defined as complete ablation of the nidus, while clinical success was defined as a post-procedure VAS score of ≤3. Results: The mean age of the 19 patients who underwent thermal ablation was 13.6 years. Of the cohort, 36.8% (n=7) were female, and 63.2% (n=12) were male. The mean nidus diameter was 4.57 mm. The mean pre-procedure VAS score was 8.32, which significantly decreased to 1.11 on the first day post-procedure and 0.37 at the first-month follow-up. The technical success rate was 100%, while the clinical success rate was 95%. Minor complications were observed in 10.53% of cases, and major complications were reported in 5.26% of cases. Subgroup analyses revealed significant differences in pain perception between pediatric and adolescent patients before the procedure, but all groups showed statistically significant reductions in VAS scores post-procedure. Conclusion: CT-guided PTA techniques are effective, safe, and minimally invasive treatment options for osteoid osteoma. In addition to high technical and clinical success rates, they offer a rapid recovery period. The findings support the use of PTA techniques as a first-line treatment option for OO. However, due to the retrospective study design, larger, multi-center, prospective randomized studies are required to confirm and expand these findings.