PMC6442330_01
CT scan and MRI of the spine and bone scan. The CT scan shows a rounded osteolytic lesion surrounded by sclerotic bone. Its size is inferior to 15 mm of diameter, within a nidus. MRI shows a T2 hypersignal and a T1 hyposignal on the right side of the T1 vertebra, until the vertebral body with an attachment to the pedicle, and an inflammation of the right T1 root. The bone scan shows hyperfixation of the right T1 vertebra region.
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T1 root (Figure 1). The radioisotope bone scanning showed lateral hyperfixation on the right of the T1 vertebra (Figure 1). The CT scan revealed a rounded osteolytic lesion surrounded by sclerotic bone at the medial wall of the right T1 pedicle (Figure 1). The lesion was adjacent to the dura mater and T1 spinal nerve. The aspect was compatible with a nidus, typically found in osteoid osteoma.
Patient reference in Surgivisio . The reference frame is fixed to the patient using 2 to 4 pins introduced into spinous processes. We can first put an imaging reference frame (a), then another reference frame for the navigation (b).
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A reference frame was fixed with four pins through the thoracic spinous processes on the midline (Figure 2).
Intraoperative aspect. Navigation imaging (a). We can notice the nidus aspect close to the navigated trocar. The blue landmarks are separated 1 cm each. Reference frame and navigation trocar (b). Mini-open access, with the partial right laminectomy of the T1 vertebra (c) less than 1 cm square-sized. We can notice the pin inside the spinous process of the T1 vertebra.
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A 1 cm square-sized cortical bone surface was removed giving access to the exact localization of the lesion (Figure 3).
Postoperative spine CT scan after one week. The images confirmed the complete resection of the lesion, without destabilizing the vertebral column.
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CT scan was performed the next week and confirmed full osteoma resection (Figure 4).
Histopathological examination (standard coloration). An area of hypovascular sclerotic bone surrounding the tumor is seen at low (x100) magnification (a, left part). The intertrabecular space is filled with fibrovascular stroma (a, right part). The central portion of the lesion (nidus) is characterized by differentiating osteoblasts engaged in the production of osteoid tissue. Absence of mitoses and necrosis. (b) x400 magnification.
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The histological examination was consistent with an osteoid osteoma (Figure 5).