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Purpose: To compare technical success, complications, and long-term clinical success following radiofrequency ablation of osteoid osteomas in pediatric and adult patients., Materials and Methods: Ninety-two patients underwent percutaneous computed tomography-guided radiofrequency ablation for osteoid osteomas including 54 pediatric (mean age 12.9 years) and 38 adult (mean age 24.1 years) patients. Presenting indication, osteoma location, ablation method, technical success, complications, visual analog score, radiographic follow-up, clinical success, reintervention rate, and total follow-up were reported. Technical success was defined as placement of the probe in the radiolucent nidus with ablation. Clinical success was defined as resolution of symptoms., Results: Ablation indications included: pain localized to the lesion, night pain, and an osteoma on imaging in all patients. Majority of osteoid osteomas were localized to the femur (pediatric [n = 22, 40.7%]; adult [n = 12, 34.2%]) and tibia (pediatric [n = 21, 38.9%]; adult [n = 10, 26.3%]). Mean lesion size was 9.6 mm in pediatric patients and 9.0 mm in adults. Technical success was achieved in all pediatric patients (100%) and 97.4% of adults. Two complications occurred. Primary clinical success was achieved in 49 (90.7%) pediatric and 35 (92.1%) adult patients. Five (9.3%) pediatric and 3 (7.9%) adult patients sought reintervention for residual symptoms, and all had secondary clinical success. Mean total follow-up was 95.2 ± 58.7 months in pediatric and 90.0 ± 61.6 months in adult patients. No differences in outcomes were identified between pediatric and adult patients., Conclusion: Radiofrequency ablation of osteoid osteomas is safe with excellent technical and clinical success rates in pediatric and adult patients.