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DOI: 10.1055/s-0028-1109424
© Georg Thieme Verlag KG Stuttgart · New York
Perkutane Radiofrequenzablation von Osteoidosteomen: Technik und Ergebnisse
Percutaneous Radiofrequency Ablation of Osteoid Osteomas: Technique and ResultsPublikationsverlauf
eingereicht: 17.2.2009
angenommen: 31.3.2009
Publikationsdatum:
10. Juni 2009 (online)
![](https://www.thieme-connect.de/media/roefo/200908/lookinside/thumbnails/10.1055-s-0028-1109424-1.jpg)
Zusammenfassung
Ziel: Das Osteoidosteom ist ein benigner, primärer Knochentumor, der typischerweise im Kindes- und jungen Erwachsenenalter auftritt. Neben den lokalen Schmerzen, die häufig nachts zunehmen, ist das gute Ansprechen dieser Symptomatik auf Acetylsalicylsäure (ASS) für diese Knochenläsion charakteristisch. Da eine Dauertherapie mit ASS aufgrund der möglichen unerwünschten Wirkungen keine langfristige Behandlungsoption bietet, sind neben der chirurgischen Behandlung verschiedenen minimalinvasive, bildgeführte Verfahren zur Therapie des Osteoidosteoms entwickelt worden. In den letzten Jahren hat sich dabei vor allem die perkutane Radiofrequenz(RF)-Ablation in der klinischen Routine etabliert, deren Ergebnisse und Technik mit denen alternativer Verfahren verglichen wird. Material und Methode: Im Rahmen der RF-Ablation wird bildgeführt eine meist nadelförmige RF-Sonde perkutan im Tumor platziert. Anschließend wird ein hochfrequenter Wechselstrom appliziert, der über eine Ionenbewegung im Gewebe zur lokalen Hitzeentwicklung und damit zur thermischen Destruktion des umliegenden Gewebes einschließlich des Tumors führt. Ergebnisse: Die primäre bzw. sekundäre Erfolgsrate dieses Verfahrens beträgt bei weit über 700 publizierten Fällen 87 bzw. 83 %. Die chirurgische Resektion oder Curettage zeigt ähnliche Ergebnisse, ist jedoch mit einer deutlich höheren Komplikationsrate verbunden. Zusätzlich bietet die RF-Ablation die vergleichsweise niedrigsten Kosten. Schlussfolgerung: Zusammenfassend kann die RF-Ablation heute als Goldstandard für die Therapie des Osteoidosteoms gelten.
Abstract
Purpose: Osteoid osteoma is a benign primary bone tumor that typically occurs in children and young adults. Besides local pain, which is often worse at night, prompt relief due to medication with acetylsalicylic acid (ASS) is characteristic for this bone lesion. Because long-term medication with ASS does not represent an alternative treatment strategy due to its potentially severe side effects, different minimally invasive image-guided techniques for the therapy of osteoid osteoma have been developed. In this context radiofrequency (RF) ablation in particular has become part of the clinical routine. The technique and results of image-guided RF ablation are compared to alternative treatment strategies. Materials and Methods: Using this technique, an often needle-shaped RF applicator is percutaneously placed into the tumor under image guidance. Then a high-frequency alternating current is applied by the tip of the applicator which leads to ionic motion within the tissue resulting in local heat development and thus in thermal destruction of the surrounding tissue including the tumor. Results: The published primary and secondary success rates of this technique are 87 and 83 %, respectively. Surgical resection and open curettage show comparable success rates but are associated with higher complication rates. In addition image-guided RF ablation of osteoid osteomas is associated with low costs. Conclusion: In conclusion image-guided RF ablation can be considered the gold standard for the treatment of osteoid osteoma.
Key words
bones - ablation procedures - CT - interventional procedures
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Philipp Bruners
Lehrstuhl für Angewandte Medizintechnik, Helmholtz Institut für Biomedizinische Technik, RWTH Aachen
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