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Alexander Glaessl, MD; Andreas G. Schreyer, MD; Monika B. Wimmershoff, MD; Michael Landthaler, MD; Stephan Feuerbach, MD; Ulrich Hohenleutner, MD

Arch Dermatol. 2001;137:1331-1335.

Background  Three-dimensional (3-D) imaging using computed tomography or magnetic resonance imaging data is well known for surgical planning of complex lesions in neurosurgery. In dermatology, percutaneous and intralesional Nd:YAG laser therapy is well established for numerous types of vascular malformations. Diagnostic imaging using ultrasound, computed tomography, or magnetic resonance imaging is necessary to plan the laser therapy of those malformations. 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 anatomical extent and subcutaneous involvement for laser surgical planning. Percutaneous and intralesional laser therapy was performed at 3-month intervals with the Nd:YAG laser using the 3-D reconstruction as a road map for the Nd:YAG 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 exactly. 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 and improve the intralesional laser therapy in the treatment of venous malformations.

From the Departments of Dermatology (Drs Glaessl, Wimmershoff, Landthaler, and Hohenleutner) and Radiology (Drs Schreyer and Feuerbach), University of Regensburg, Germany.

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