1. Ultrasound Guided Intralesional Laser Treatment of Vascular Malformations and Deep Hemangiomas by 1470 nm Laser
Smucler R.1,2, Ott Z.2, Andrle P.2
1 Medical Faculty Plzen, Charles University, Plzen, Czech Republic
2Asklepion- Laser Centre Prague, Prague, Czech Republic ,,
3Institute, Department, City, Country, 4Institute, Department, City, Country [size 27 p., bold]
| Background
Vascular malformations in head and neck region remains challenging pathology with significant morbidity. They are many treatment options but without single really effective modality. Laser coagulation with fiber inserted directly into tumor is one of them. But without navigation it seems to be adventurous surgery in complicated anatomy of face and it is very difficult to replicate. Some authors promote MRI or CT as perfect tools for planning and control but protocols are complicated not speaking about economy. Ultrasound with modern guiding seems to be more accessible for daily praxis. Majority of papers are written about Nd:YAG laser which we see as potentially dangerous because of large zone of irreversible thermal damage. Modern 1470 nm diode laser seems to be more precise, safe and technologically simple. Aim of this work is to validate effectiveness of this tool in one-year study.
| Methods
30 verified vascular malformations. We provided intravascular application of 1470 nm laser light into tumor under control of ultrasound in whole volume with power ranging from 5-10 W. Total dose was J according to tumor size. Patients were monitored every month; in case of recidive we indicated additional treatment. Blinded, independent evaluator, ultrasound controls.
| Results
All tumors were eliminated or smaller under 25% of original size with perfect control from sensitive anatomical structures (bone, nerves) in average 2,1 sessions.; Deep heamngiomas or AV Malformation (extra- MF location) were treated completely in one session. Maxillofacial region is more demanding (see Table). Complete tumor removal was achieved in only 21 cases after 3 treatments (70%), in MF region in 3 out of 7 lesions.
Nr. of. Patient with MF AV Malformation
Nr. of Treatments
Residuum in % 1
<5% 2 3 0% 4 5
<10% 6 7
<25%
Result -Combined Tx Laser and Batablockers
Partial elimination tongue
Before Laser Treatment After 1 Week After 1 Month
Complete elimination – Laser only
| Conclusion
Ultrasound guided intralesional coagulation of vascular malformations seems to be at least one of most effective methods with low level of complications, acceptable economy and little side-effects. Complete elimination of tumor is difficult to promise, because of coagulation near to sensitive structures like n. facialis, bones or facial muscles in MF region. Control of tumor, which is leading to stabilization of disease, is nearly guaranteed.
Burstein, FD; Simms, C; Cohen, SR; et al. Intralesional laser therapy of extensive hemangiomas in 100 consecutive pediatric patients, ANNALS OF PLASTIC SURGERY  Volume: 44   Issue: 2   Pages:   Published: FEB 2000
Leaute-Labreze, Christine; de la Roque, Eric Dumas; Hubiche, Thomas; et al. Propranolol for severe hemangiomas of infancyNEW ENGLAND JOURNAL OF MEDICINE  Volume: 358   Issue: 24   Pages:   Published: JUN
Hintringer, T.Treatment of Haemangiomas and Vascular Malformations with the Neodymium-YAG Laser - Strategy and Results in over 2000 Cases HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE  Volume: 41   Issue: 2   Pages:   Published: APR 2009