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Keywords:
Extremities, Musculoskeletal bone, Interventional non-vascular, Percutaneous, CT, Ablation procedures, Biopsy, Neoplasia
Authors:
�. Bueno Horcajadas, J. Martel Villagrán, I. Rozas Gómez, I. López-Vidaur, E. Ortiz; Alcorcón/ES
DOI:
10.1594/ecr2015/C-1479
Methods and materials
We report four recurrent GCTs from our institutions,
successfully treated by means of percutaneous radiofrequency thermal ablation (from 2009 to 2014).
The recurent GCTs were located in:
Case 1: lateral cuneiform bone of the right tarsus
Case 2: distal epiphysis of left the tibia involving subchondral cortical bone.
Case 3: greater tuberosity of the right femur.
Case 4: Iliac bone with break of the subchondral cortical of acetabulum and tumor growing into the hip joint.
All four patients had a bone giant cell tumor diagnosed by percutaneous CT guided biopsy and subsequent surgery.
One or several surgeries were performed in all patients with intra-lesion extended resection with curettage plus high speed burr (B),
pulsatile lavage (C),
phenol (D),
and reconstruction with bone allograft (E) (Fig. 1 ,
from the case 1).
Recurrence of bone GCT was confirmed by percutaneous biopsy in all of the cases ( Fig. 2 ).
The local recurrence was treated in all patients by percutaneous CT guided radiofrequency thermal ablation.
Before undergoing RF ablation,
written informed consent was obtained from each patient.
All candidates were informed of alternative treatments.
Procedures were carried out under general anaesthesia in the CT room.
The technique used was the same as it has been described in the literature for osteoid osteoma.
We reached the intra-bone lesion with an 11-13 gauge (G) bone biopsy needle.
The drill was removed and exchanged for a 17 G monopolar RF electrode (Cool-tip Covidien RAF System) to place the active tip (7-10 mm) of the electrode-needle inside the lesion ( Fig. 3 ). Radiofrequency-activation time was 3-5 min providing that the core temperature reached a minimum range of 90 â—¦C.
(No cooling activation ).