CO2 Laser Treatment of Neurofibromas of Patients with Neurofibromatosis Type 1:Five Years Experience

The Neurofibromatosis type 1 (NF1) is an autosomal dominant heritable disorder with high variability of clinical expression. The most common disfigurement of the patients is the development of complex plexiforme and thousands of dermal neurofibromas causing beneath other complications stigmatisation and social problems in the private or professional surrounding. Despite of intensive investigations of the aetiology and pathogenesis of NF1 no systemic treatments to prevent the growth of neurofibromas are available. Up to now the surgical or laser surgical removal of the neurofibroma remains the treatment of first choice.

After the retirement of D. Katalinic we established on the basis of his experience the CO₂ laser therapy of NF1 in our clinic. Up to now 119 patients were treated and about 75 000 neurofibromas were removed in 216 sessions. Most of the patients had thousands of neurofibromas so that repetitive treatments were necessary. The average age of the patients was 41 years (range 4–62 years) with a distribution of sex of 1:1.9 (male:female). All treatments were done in general anaesthesia with an average operation time of about 2h (range 30 min to 4h15min). On average 58 (range 1–300) large neurofibromas (1–15 cm size) and 355 (15–1013) small neurofibromas (>1cm size) were removed in one session depending on the total amount, subtype, size and localisation of the neurofibromas and the requests of the patients. On average the in-patient treatment lasted 6.5 days (range 59 days). The wounds closed after 6 weeks or earlier and the cosmetic results were excellent to average if all the recommendations for postoperative wound care were followed.

Most of the patients reported an increase in self-confidence and acceptance of the social surrounding. Only three patients developed hypertrophic scars because the local treatment with triamcinolone ointment which should prevent the formation of hypertrophic scars was discontinued.

Our experience has shown that the removal of neurofibromas with CO₂ laser proved to be a rapid, low cost procedure to remove hundreds of neurofibromas in one session and even although the neurofibromas were replaced by white depigmented scars the patients lost their stigmatisation and won more self-confidence.