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BACKGROUND: Image-guided percutaneous microwave ablation is a minimally invasive procedure to treat osteoid osteomas(OOs) but has not been thoroughly evaluated in Pakistan and few pilot studies have been published in the world literature. PURPOSE: The purpose of this study is to evaluate efficacy and safety of CT guided microwave ablation (MWA) of osteoid osteomas(OOs). MATERIALS AND METHODS: This retrospective study included four consecutive patients with computed tomographic (CT) diagnosis of OOs treated by CT guided MWA from January 2017 to December 2018. Under general anesthesia and CT guidance MWA of OOs done. DATA i.e. age, gender of patients, severity of pre-procedural pain, site and nidus size, procedure time and post procedural pain resolution were assessed. Pain resolution was clinically assessed by using visual analog score (VAS) on 1st day, 15 days and one month after ablation and any need for re ablation. Safety was assessed based on complication rate i.e. hematoma, burns or infection. RESULTS: All procedures were technically successful and the success rate was up to 100% (5/5). One case was a previously failed Radiofrequency ablation of OOs which was followed by MWA and that was successful. Minor complications were observed and no major complication seen. CONCLUSION: MWA is a very simple, successful, minimally invasive and curative treatment for OOs without any major complications. It can be a very useful and safe tool in the management of osteoid osteoma. [ABSTRACT FROM AUTHOR]