Die Hämangiombehandlung mit dem Neodym: Yttrium-Aluminium-Granat-Laser (Nd:YAG-Laser)

Abstract

Laser therapy and in particular Nd:YAG laser therapy has become of increasing importance amongst the various methods of treating haemangiomas. Nd:YAG laser radiation penetrates deep into the tissue. To avoid undesirable results of treatment, certain treatment guidelines must be observed: to protect the tissue from serious heat damage, the Nd:YAG laser radiation should be applied exclusively with simultaneous tissue cooling. Depending on the location of the haemangioma, this is carried out with ice cubes (if possible, not containing air bubbles) or with an ice-cold Ringer solution. The depth of penetration of the laser radiation can be increased by tissue compression with a piece of ice or with a special glass disc. In very voluminous haemangiomas, the laser light is additionally applied via a bare fibre directly on to the vascular tissue. The laser power densities we use are between 500 and 3,000 watts/cm2. The power chosen depends on the tissue effect of the laser radiation. Blanching of the vascular tissue without carbonisation is aimed at. With consistent observance of the treatment guidelines specified, haemangiomas should be treated as early as possible with the Nd:YAG laser. The treatment principle of "wait and see" is often advocated, but we consider to be obsolete, since cosmetically and functionally unsatisfactory residual scars may remain even after complete haemangioma regression. Moreover, the progressive haemangiomas which often lead to complications cannot be distinguished from regressive haemangiomas. Last but not least, the child and the parents should be spared the (in some cases appreciable) psychological strain of a haemangioma.

Interstitielle Nd:YAG-Lasertherapie

“…Trotz einer möglichen Spontaninvolution der Hämangiome von bis zu 70% ist die früher favorisierte Therapieform des kontrollierten Abwartens ("wait and see") nach heutigem Kenntnisstand nicht mehr gerechtfertigt [10,13,26].Dies liegt zum einen an den schlechten kosmetischen und funktionellen Ergebnissen der meist erst nach Jahren auftretenden Spontaninvolutionen,zum anderen kann eine Spontaninvolution aufgrund funktioneller,kosmetischer und/oder vitaler Indikationen oftmals nicht abgewartet werden [7,10].…”

“…B. chirurgische, medikamentöse, Strahlenbehandlung) [1,2,3,4,15,20,21,22] guten therapeutischen Optionen und Ergebnissen, insbesondere bei der Nd:YAG-Lasertherapie [2,3,10,22,26,27].…”

“…Der Nd:YAG-Laser bietet, abhängig von der Lokalisation und der korrekten Indikationsstellung zur Lasertherapie die besten Voraussetzungen für den klinischen Einsatz bei der interstitiellen und/oder perkutanen Lasertherapie von Hämangiomen und vaskulären Malformationen unterschiedlicher Größe und Ausdehnung [4,5,6,10,16,20,22,26,27].…”

Aktueller Stand der Lasertherapie in der Dermatologie

“…Der kontinuierlich betriebene Nd:YAGLaser wird vorwiegend von Gewebspigmenten absorbiert [146]. Die Hautoberfläche wird ohne wesentlichen Energieverlust durchdrungen, der Laserstrahl dringt 6-10 mm tief in das Gewebe ein [97,130].…”

The effect of cold-air anesthesia during fractionated carbon-dioxide laser treatment: Prospective study and review of the literature

“…[1][2][3][4][5][6][7][8] In contrast to the classic use of cryotherapy in dermatology for cold-induced tissue destruction, cryoanesthesia is ideally meant to cool only the epidermis to anesthetize and thermally protect it during laser treatment. [8][9][10][11][12][13][14][15][16] Furthermore, cryoanesthesia is designed to influence the laser beam as little as possible in intensity and direction. The literature on cryoanesthesia differentiates between contact cooling and noncontact cooling.…”