Laser surgical planning with magnetic resonance imaging-based 3-dimensional reconstructions for intralesional Nd : YAG laser therapy of a venous malformation of the neck

Background: Three-dimensional (3-D) imaging using computed tomography or ma gnetic resonance imaging data is well known for surgical planning of comple x lesions in neurosurgery. In dermatology, percutaneous and intralesional N d:YAG laser therapy is well established for numerous types of vascular malf ormations. Diagnostic imaging using ultrasound, computed tomography, or mag netic resonance imaging is necessary to plan the laser therapy of those mal formations. The therapeutic problem is to localize the venous malformation exactly before treatment on sectional 2-dimensional images. Observations: We describe a 27-year-old woman with a venous malformation of the neck. The data of diagnostic magnetic resonance imaging were used for a 3-D reconstruction of the venous malformation to demonstrate the anatomic al extent and subcutaneous involvement for laser surgical planning. Percuta neous and intralesional laser therapy was performed at 3-month intervals wi th the Nd:YAG laser using the 3-D reconstruction as a road map for the Nd:Y AG laser. Eight weeks after the last laser treatment, the bulky lesions of the neck showed regression. Using the 3-D reconstruction for laser surgical planning, physicians could perform intralesional laser treatment more exac tly. The complex anatomy of the venous malformation could be elucidated by studying the 3-D images before and during laser surgery. Conclusion: The use of magnetic resonance imaging-based 3-D reconstructions for laser surgical planning can demonstrate the often unexpected extent an d improve the intralesional laser therapy in the treatment of venous malfor mations.