Objective: To report a single-center experience comparing the efficacy and safety of computed tomography (CT)–guided radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in pediatric and adult patients. Materials and methods: The electronic medical records of 97 patients who underwent CT-guided RFA for OO between January 2019 and January 2025 were retrospectively reviewed. Patients were divided into pediatric and adult groups. Demographic data, anatomical location and size of the lesion, procedure duration, pre- and post-procedure visual analog scale (VAS) scores, complications, technical and clinical success rates, and recurrence rates were evaluated. Results: Of the 97 patients, 51 (52.6%) were pediatric and 46 (47.4%) were adults. The mean lesion diameter was 7.98 ± 2.92 mm in the pediatric group and 7.14 ± 3.72 mm in the adult group. The overall technical success rate of CT-guided RFA for OO was 100%, with primary and secondary clinical success rates of 97.9% and 98.9%, respectively. The primary clinical success rate was 98.1% (50/51) in the pediatric group and 97.8% (45/46) in the adult group. No major complications related to the procedure were observed. Minor complications included transient skin burn in one pediatric patient (1.9%, 1/51) and localized muscle pain in one pediatric (1.9%, 1/51) and one adult (2.2%, 1/46) patient. Conclusion: This study demonstrates that percutaneous CT-guided RFA is a highly effective and safe technique with high success and low complication rates for the treatment of OO in both pediatric and adult populations.