Interstitial laser therapy in hemangiomatosis of the liver - A case report

Abstract

Objective: Diffuse neonatal hemangiomatosis (DNH) is a severe disease with multiple organ involvement. If left untreated, it results in high mortality rates. Death occurs due to intractable heart failure following arteriovenous shunting or due to massive cerebral or gastrointestinal bleeding. If there are large liver hemangiomas and medical treatment is not sufficient, it is necessary to use interventional or surgical procedures such as embolization or ligation of the hepatic artery. We present another local tumor destruction procedure to treat liver hemangiomas in DNH, the interstitial laser therapy (ILT). Method: ILT was performed in a 3-month-old male infant suffering from DNH with intractable heart failure and multiple liver hemangiomas. Due to the severity of the infant's condition and the minimally invasive character of the treatment, the ILT was performed directly in the neonatal intensive care unit. The ILT was carried out percutaneously by guiding a bare fiber (0.6 mm core diameter) via a puncture needle into the pathologically altered liver region. A Nd:YAG laser (1064 nm) was used as a light source for ILT because its light penetrates deeply into biological tissue. Tissue destruction was achieved with moderate laser power of 4-6 W and a long application time of 90-300 s. Using these applied physical laser parameters, almost spherical volumes of coagulation necrosis could be obtained with diameters of up to 1-2 cm. Puncture and the laser application were monitored by color-coded duplex sonography (CCDS). A decrease in color signal intensity at the tip of the bare fiber indicated the increasing tissue coagulation during application time. Results: After 2 sessions of ILT of liver manifestation in 10 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 of origin but he died 3 months later of intracranial bleeding. Conclusion: In our opinion interstitial laser therapy can be an effective minimally invasive method to treat life-threatening liver hemangiomas in diffuse neonatal hemangiomatosis. © 2009 Elsevier GmbH. All rights reserved.