4.09] Interstitial laser therapy of hemangiomatosis of the liver

Abstract

Objective Diffuse neonatal hemangiomatosis (DNH) is a severe disease with multiple organ involvement. Untreated, there is a high mortality of approximately 60%. Death occurs due to intractable heart failure following arterio-venous shunting or due to massive cerebral or gastrointestinal bleeding. If there are large liver hemangiomas and medical treatment is not sufficient, interventional or surgical procedures like embolization or ligation of the hepatic artery has been used. We present another local tumor destruction procedure to treat liver hemangiomas in DNH, the interstitial laser therapy (ILT). Patient and methods We performed ILT in an infant with intractable heart failure in large liver hemangiomas in DNH. Due to the severe condition of the infant and the minimally invasive character of the treatment we performed the ILT directly in the neonatal intensive care unit. The ILT was carried out by guiding the laser applicator via a puncture needle into the pathologically altered liver region. Due to photon absorption and heat conduction coagulative and hyperthermic effects were obtained leading to an immediate or delayed tissue destruction. As light source for ILT a Nd:YAG laser (1064 nm) was used because its light penetrates deeply into biological tissue. Tissue destruction was achieved with moderate laser power of 5 W and a long application time of 90–300 s. With these applied physical laser parameters nearly spherical volumes of coagulation necrosis could be obtained showing diameters of up to 1–2 cm. The puncture and the laser application were monitored by color-coded duplex sonography (CCDS). The decrease in intensity of color signal at the tip of the bare fiber indicates the increasing tissue coagulation during application time. Results After 2 sessions of ILT of liver manifestation in ten days the cardiac output was reduced by 50%. Postoperative Doppler imaging showed fibrosis in the treated areas of the liver. The child was transferred back to his country. The boy died 2 month later because of progressive cranial and pulmonary manifestation. Conclusion In our opinion interstitial laser therapy can be an effective minimally invasive method to treat life threatening liver hemangiomas in diffuse neonatal hemangiomatosis.