Eyrich G K, Bruder E, Hilfiker P, Dubno B, Quick H H, Patak M A, Grätz K W, Sailer H F
Department of CranioMaxillofacial Surgery, University Hospital Zürich, Ch-8091 Zürich, Switzerland.
Lasers Surg Med. 2000;26(5):467-76. doi: 10.1002/1096-9101(2000)26:5<467::aid-lsm6>3.0.co;2-8.
Lymphangiomas of the tongue and neck are uncommon benign congenital lymphatic tumors. These vascular lesions are difficult to treat, frequently recur, and can cause patients significant morbidity. Treatment may also be complicated by adjacent vital anatomic structures. Magnetic resonance (MR)-controlled laser-induced interstitial thermotherapy (LITT) has been proven to be a noninvasive safe treatment. Real-time monitoring of tissue temperature with thermosensitive sequences allows controlled coagulation necrosis.
STUDY DESIGN/MATERIALS AND METHODS: LITT was performed in a lymphangioma specimen ex vivo. In four patients (eight procedures) with lymphangiomas of the tongue and neck, MR-guided LITT was performed with a percutaneous approach in a multiapplicator technique. The laser system consisted of a titanium catheter and a protective catheter. The dome of the fiber end had a diameter of 1.4 mm with an active length of 20 mm. Temperature sensitive sequences were used in a 0.5 T open-configured MR scanner with the proton frequency shift technique to map the spatial and temporal distribution of Nd:YAG laser effects (7 Watts, 30 pulses per second, 10 minutes/location). Postoperative MR follow-up was performed at 1 week and at 3 months. In three patients, partial resection of the tumor was performed 6 months after LITT.
In three patients, MR clearly showed a diminished tumor volume. All four patients reported subjective amelioration and in three patients former functional problems, such as speech and swallowing were improved. MR thermometry allowed accurate demarcation of changes by heat and distinction of affected tumor volume (3.0 cm +/- 0.3 cm). The histology of the patients 6 months after LITT showed laser-induced fibrosis of former lymphatic tissue.
The results suggest that LITT can be performed safely with tissue preserving of vital structures and can be effective in the treatment of deep tumors, such as lymphangiomas. However, given the nature of the lesion, the potential for recurrence exists no matter what modality is chosen.
舌颈部淋巴管瘤是一种罕见的先天性良性淋巴管肿瘤。这些血管性病变难以治疗，常易复发，可给患者带来严重的发病情况。治疗还可能因邻近重要解剖结构而变得复杂。磁共振（MR）引导下的激光诱导间质热疗（LITT）已被证明是一种无创安全的治疗方法。利用热敏序列对组织温度进行实时监测可实现可控的凝固性坏死。
研究设计/材料与方法：在离体淋巴管瘤标本上进行LITT。对4例（8次手术）舌颈部淋巴管瘤患者采用多探头技术经皮途径进行MR引导下的LITT。激光系统由一根钛导管和一根保护导管组成。光纤末端的球部直径为1.4毫米，有效长度为20毫米。在一台0.5T开放式配置的MR扫描仪中使用温度敏感序列及质子频率偏移技术来描绘钕钇铝石榴石（Nd:YAG）激光效应（7瓦，每秒30个脉冲，每个部位照射10分钟）的空间和时间分布。术后1周和3个月进行MR随访。3例患者在LITT术后6个月进行了肿瘤部分切除术。
3例患者的MR检查清楚显示肿瘤体积缩小。所有4例患者均自述症状改善，3例患者之前存在的如言语和吞咽等功能问题也得到改善。MR测温能够准确界定热引起的变化并区分受影响的肿瘤体积（3.0厘米±0.3厘米）。LITT术后6个月患者的组织学检查显示先前淋巴管组织出现激光诱导的纤维化。
结果表明，LITT能够在保留重要结构组织的情况下安全进行，并且对深部肿瘤如淋巴管瘤的治疗可能有效。然而，鉴于病变的性质，无论选择何种治疗方式都存在复发的可能性。
