From November 2011,
we selected 9 surgically untreatable bone lesions including four osteoid osteomas located: in the femoral epiphysis (n.1),
in the tibial diaphysis (n.
2),
and in the talus (n.
1); two chondroblastomas of the knee tibial plateau (n.
2) with a mean diameter of 30 mm; two fibroangiomas of the humeral head (n.
1) and foot (n.
1); one periosteal chondroma of the femoral neck (n.1).
Patient age ranged between 13 and 30 years (mean age,
21 years).
All the lesions were studied by plain films,
CT (Toshiba Aquilion One,
Toshiba Medical System Corporation) and MRI (Signa 1.5 T,
GE).
The inclusion criteria were a pre-treatment VAS of at least 7,
and the site of the lesion.
In concert with the orthopedic surgeons,
we decided to treat those patients in whom a surgical treatment would have been too invasive as compared to the stage of the lesion.
All patients were treated using MRgFUS (ExAblate 2000,
InSightec,
Israel).
In 7 patients,
spinal anesthesia was performed (hyperbaric bupivacaine 0.5%); only in the two patients with chondroblastoma general anesthesia was performed (i.v.
propofol and remifentalin) to obtain a better cooperation (very young patients).
The total duration of the treatments ranged from 1 to 2 hours; for each treatment a long time (from 20 minutes to 1 hour) was spent in patient positioning and calibration phases.
We used a mean sonication number of 12 (between 6 and 24).
In all patients,
MRI was performed immediately after treatment and at the distance of 3 and 6 months.
After the treatment,
all the patients underwent pain therapy through elastomer for a duration of 30 hours and steroid therapy for the 3 days after the treatment (gastric protection was provided).
All patients were discharged from the hospital on the day following the treatment.
In no case,
major complications were observed.