Temperature distributions in laser-heated biological tissue with application to birthmark removal

Potential surgical therapies for drug-resistant focal epilepsy

Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.

Relationships of skin depths and temperatures when varying pulse repetition frequencies from 2.0-microm laser light incident on pig skin

Human perception of 2.0-microm infrared laser irradiation has become significant in such disparate fields as law enforcement, neuroscience, and pain research. Several recent studies have found damage thresholds for single-pulse and continuous wave irradiations at this wavelength. However, the only publication using multiple-pulse irradiations was investigating the cornea rather than skin. Literature has claimed that the 2.0-microm light characteristic thermal diffusion time was as long as 300-ms. Irradiating the skin with 2.0-microm lasers to produce sensation should follow published recommendations to use pulses on the order of 10 to 100 ms, which approach the theoretical thermal diffusion time. Therefore, investigation of the heating of skin for a variety of laser pulse combinations was undertaken. Temperatures of ex vivo pig skin were measured at the surface and at three depths from pulse sequences of six different duty factors. Differences were found in temperature rise per unit exposure that did not follow a linear relation to duty factor. The differences can be explained by significant heat conduction during the pulses. Therefore, the common heat modeling assumption of thermal confinement during a pulse may need to be experimentally verified if the pulse approaches the theoretical thermal confinement time.

Semianalytical thermal model for subablative laser heating of homogeneous nonperfused biological tissue: application to laser thermokeratoplasty

We present a semianalytical technique to calculate the temperature in homogeneous nonperfused tissue during subablative laser heating. Analytical expressions of the temperature distribution in time and space are provided for collimated beams with Gaussian and top-hat intensity distributions perpendicularly incident on a finite tissue slab. The temperature distribution produced with a collimated Gaussian beam is the triple sum of the product of four functions of separate variables. The semianalytical technique can be used to rapidly calculate the temperature in laser-irradiated tissue at any point in time and space. The model was used to estimate the corneal temperature during pulsed holmium:YAG laser thermokeratoplasty with various boundary conditions at the anterior and posterior corneal surface. The model demonstrates that the corneal temperature during laser thermokeratoplasty (LTK) with a pulsed Ho:YAG laser may be sufficient to induce superficial vaporization of epithelial cells and local thermal damage to the endothelium. The calculations show that convection at the anterior corneal surface does not have a significant effect on the corneal temperature distribution, but that a better knowledge of the cooling effect of the aqueous is required to better estimate the corneal temperature distribution during LTK.

Optimum pulse duration and radiant exposure for vascular laser therapy of dark port-wine skin: a theoretical study

Laser therapy for cutaneous hypervascular malformations such as port-wine stain birthmarks is currently not feasible for dark-skinned individuals. We study the effects of pulse duration, radiant exposure, and cryogen spray cooling (CSC) on the thermal response of skin, using a Monte Carlo based optical-thermal model. Thermal injury to the epidermis decreases with increasing pulse duration during irradiation at a constant radiant exposure; however, maintaining vascular injury requires that the radiant exposure also increase. At short pulse durations, only a minimal increase in radiant exposure is necessary for a therapeutic effect to be achieved because thermal diffusion from the vessels is minimal. However, at longer pulse durations the radiant exposure must be greatly increased. There exists an optimum pulse duration at which minimal damage to the epidermis and significant injury within the targeted vasculature occur. For example, the model predicts optimum pulse durations of approximately 1.5, 6, and 20 ms for vessel diameters of 40, 80, and 120 microm, respectively. Optimization of laser pulse duration and radiant exposure in combination with CSC may offer a means to treat cutaneous lesions in dark-skinned individuals.