The recognition, investigation and management of osteoid osteoma has been well documented. Treatment can either be medical or surgical, studies have shown both options to have almost equal long term outcomes. However only surgical treatment involving complete excision of the lesion allows for confirmatory tissue diagnosis of osteoid osteoma especially important in cases where symptoms and signs are atypical. Several methods of surgical treatment with varying degrees of success have been described in literature. Here we describe a surgical techniques for the treatment of osteoid osteoma which enables removal of the lesion in a precise manner using a precision bone graft trephine with minimal excision of bone. This technique will be very useful in the excision of lesions in areas in which excessive excision of bone can lead to an unstable bony structure which can predispose to fracture. To our knowledge this surgical technique in the management of osteoid osteoma has not been described in the literature.