INTERSTITIAL ND-YAG PHOTOCOAGULATION FOR VASCULAR MALFORMATIONS AND HEMANGIOMAS IN CHILDHOOD

Background: Vascular malformations and cavernous hemangiomas are commo n in childhood. Although cavernous hemangiomas may resolve spontaneous ly, aggressive intervention is required when their growth could damage vital adjacent structures, such as the orbit, nose, or tongue. Object ive: To evaluate the efficacy of interstitial Nd:YAG photocoagulation as an adjunct to intralesional and systemic corticosteroids for treatm ent of hemangiomas and vascular malformations that had failed to respo nd to other therapies. Design: Prospective, nonrandomized trial. Setti ng: Two referral practices of facial plastic and reconstructive surger y in tertiary care, academic medical centers. Patients: Ten consecutiv e pediatric patients with either hemangioma or vascular malformation o f the head and neck. Intervention: Laser photocoagulation with an inte rstitial technique. The Nd:YAG fiber was introduced into the lesion vi a a 14-gauge angiocatheter needle, and the laser fiber was advanced as coagulation proceeded within the tissue. Main Outcome Measures: Decre ase in the area of the target lesion, amount of energy applied, and nu mber of treatments required to achieve reduction in size. Results: Lon g-term follow-up demonstrated regression of the lesion in all 10 patie nts with good cosmetic results. The range of reduction in size was 20% to 98%. No reexpansion of the lesions was noted after a mean follow-u p of 13 months. Conclusions: Interstitial photocoagulation of hemangio mas and vascular malformations is an effective treatment for carefully selected patients. When properly applied, this technique can achieve reduction in the size of these lesions without compromising cosmesis.