Staging and treatment of primary and persistent (recurrent) osteoid osteoma. Evaluation of intraoperative nuclear scanning, tetracycline fluorescence, and tomography.

The purposes of this study were (1) to evaluate the various methods of preoperative staging of osteoid osteomas, (2) to compare the different methods of intraoperative localization and excision of the tumor, and (3) to develop a clinical strategy for the treatment of persistent (recurrent) lesions. From 1978 until 1986, 14 consecutive patients had excision of osteoid osteomas. All patients' operative reports, roentgenograms, bone scans, computed tomographic scans and histologic studies were reviewed. With an average follow-up period of 94.5 months, 13 of 14 patients were cured with one operative procedure. One patient required two procedures. No patient developed a recurrence. Eleven of 14 niduses were confirmed on hematoxylin and eosin sections. Computed tomographic scan was the most useful preoperative study in localizing the nidus. It helped determine the surgical approach and the portion of bone to be resected. Intraoperative nuclear scanning (IONS) is a reliable technique in confirming complete removal of the nidus, with no increase in operative time. Intraoperative scanning did not appreciably affect the amount of bone resected. Recurrent tumors can be reliably resected, with a high cure rate, by careful preoperative staging and with use of IONS.