Computed tomography guided radiofrequency ablation of osteoid osteoma in technically challenging locations: Tracking through the opposite cortex

Computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation is an established minimally invasive treatment option of osteoid osteoma. The standard technique involves the percutaneous advancement of an RF probe under CT-guidance through the cortex overlying the nidus of osteoid osteoma in a plane oriented perpendicular to the cortex. In certain specific scenarios, aiming the osteoid osteoma nidus through the overlying cortex is not feasible either due to technical limitations or due to the potential risk of complications. The nidus can be approached through the opposite unaffected cortex in these situations, obviating the need for surgical excision. Performing CT-guided RF ablation of osteoid osteoma through the opposite unaffected cortex is a technically demanding procedure; and, thus requires a high level of expertise. There is a paucity of literature highlighting the RF ablation procedure in technically challenging locations and thus forms the cornerstone of our current technical note.