Edward Y Cheng1, Sameer M Naranje1. 1. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, R 200, Minneapolis, MN 55454. E-mail address for E.Y. Cheng: cheng002@umn.edu.
Abstract
INTRODUCTION: During the performance of radiofrequency ablation of osteoid osteomas, the use of intraoperative cone-beam computed tomography (CT) imaging with surgical navigation lowers radiation exposure while allowing real-time targeting of the nidus. STEP 1 PREOPERATIVE PLANNING: Review all images to confirm a high level of confidence in the radiographic diagnosis. STEP 2 PATIENT POSITIONING AND SETUP: Be sure to position and set up properly. STEP 3 PLACEMENT OF TRACKING OPTICAL ARRAY: Attach the optical array to the target bone. STEP 4 O-ARM SETUP INITIAL CT IMAGING FOR SURGICAL NAVIGATION AND REMOTE MOUSE REGISTRATION: Set up the intraoperative CT (O-Arm) machine and acquire the initial images for surgical navigation. STEP 5 CT DATA INTERPRETATION AND APPROACH PLANNING: Analyze the initial images, rotated or positioned as necessary, to allow you to proceed with the planned direction and angle of approach to the nidus. STEP 6 SURGICAL NAVIGATION SETUP: Register the surgical instruments with the surgical navigation unit. STEP 7 NIDUS LOCALIZATION AND KIRSCHNER WIRE INSERTION: Target the nidus and then insert the Kirschner wire into its center. STEP 8 EXCHANGING KIRSCHNER WIRE FOR A RADIOFREQUENCY PROBE: Once the accuracy of the Kirschner wire placement is confirmed, exchange it for the radiofrequency probe and perform a CT scan to confirm proper probe placement. STEP 9 CONFIRMATION OF RFA PROBE PLACEMENT: Perform a CT scan to confirm proper placement of the probe within the center of the nidus. STEP 10 ACTIVATION OF THE RADIOFREQUENCY PROBE AND CLOSURE: Perform the radiofrequency treatment to ablate the cells within the nidus. RESULTS: We conducted a study of three different techniques of radiofrequency ablation.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: During the performance of radiofrequency ablation of osteoid osteomas, the use of intraoperative cone-beam computed tomography (CT) imaging with surgical navigation lowers radiation exposure while allowing real-time targeting of the nidus. STEP 1 PREOPERATIVE PLANNING: Review all images to confirm a high level of confidence in the radiographic diagnosis. STEP 2 PATIENT POSITIONING AND SETUP: Be sure to position and set up properly. STEP 3 PLACEMENT OF TRACKING OPTICAL ARRAY: Attach the optical array to the target bone. STEP 4 O-ARM SETUP INITIAL CT IMAGING FOR SURGICAL NAVIGATION AND REMOTE MOUSE REGISTRATION: Set up the intraoperative CT (O-Arm) machine and acquire the initial images for surgical navigation. STEP 5 CT DATA INTERPRETATION AND APPROACH PLANNING: Analyze the initial images, rotated or positioned as necessary, to allow you to proceed with the planned direction and angle of approach to the nidus. STEP 6 SURGICAL NAVIGATION SETUP: Register the surgical instruments with the surgical navigation unit. STEP 7 NIDUS LOCALIZATION AND KIRSCHNER WIRE INSERTION: Target the nidus and then insert the Kirschner wire into its center. STEP 8 EXCHANGING KIRSCHNER WIRE FOR A RADIOFREQUENCY PROBE: Once the accuracy of the Kirschner wire placement is confirmed, exchange it for the radiofrequency probe and perform a CT scan to confirm proper probe placement. STEP 9 CONFIRMATION OF RFA PROBE PLACEMENT: Perform a CT scan to confirm proper placement of the probe within the center of the nidus. STEP 10 ACTIVATION OF THE RADIOFREQUENCY PROBE AND CLOSURE: Perform the radiofrequency treatment to ablate the cells within the nidus. RESULTS: We conducted a study of three different techniques of radiofrequency ablation.IndicationsContraindicationsPitfalls & Challenges.
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