NEUROLOGY/LASER SURGERY: Minimally invasive laser surgery revolutionizes epilepsy treatment

“Based on our experience, we believe the use of MRI-guided laser surgery will change the face of epilepsy treatment and provide a life-changing option for many epilepsy surgery candidates—both children and adults,” said Dr. Angus Wilfong, director of Texas Children’s Hospital’s (TCH’s) comprehensive epilepsy program and associate professor of pediatrics and neurology at Baylor College of Medicine. The laser-based approach recently placed TCH in the spotlight, making it the first hospital to use MRI-guided thermal imaging and laser technology to destroy brain lesions that cause epilepsy and uncontrollable seizures. The approach offers a safer and much less invasive alternative to craniotomy—currently the most commonly used cranial surgical treatment for epilepsy—which requires the removal of a large area of the skull. For patients with lesions deep in the brain, the technique is particularly appealing because the laser probe requires a much smaller pathway through the brain tissue, which reduces the risk of complications. The probe fits through a 3.2 mm hole in the skull, and requires much less patient recovery time.

Nine-year-old Keagan Dysart of Converse, TX, was diagnosed with a hypothalamic hamartoma located in the hypothalamus, near his brain stem. Potential complications included loss of sight, damage to his pituitary gland, stroke from artery damage, and development of diabetes insipidus (DI). But his MRI-guided laser surgery was performed without complications, and he is now seizure-free.

Prior to surgery, doctors map the area of the lesion using magnetic resonance imaging (MRI). In the operating room, they insert a catheter through the skull and then transfer the patient to an MRI unit where they perform ablation of the lesion. The MRI confirms probe placement in the target, and magnetic resonance thermal imaging allows the surgeon to monitor ablation as it happens. An automatic feedback system shuts off the laser when heat approaches nearby critical brain structures.

All people who have received the treatment so far have been seizure-free since the surgery, and most were released within one to five days. “The benefits of this new approach in reducing risk and invasiveness while providing instant therapeutic effect may open the door for more epilepsy patients to see surgery as a viable option,” said Dr. Daniel Curry, Texas Children’s director of pediatric surgical epilepsy and functional neurosurgery.

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