Minimally Invasive Laser Ablation
In 2010, Texas Children’s Hospital was the first hospital in the world to use real-time MRI-guided thermal imaging and laser technology to eradicate lesions in the brain that cause epilepsy. Since then, the neurosurgery team at Texas Children’s Hospital has operated 140 times using the technology (as of March 2017) and is considered the premier institution performing this type of surgery. Patients travel from around the world to receive expert care from our renowned surgeons and clinical staff at our National Associations of Epilepsy Centers (NAEC) recognized Level 4 epilepsy center.
The treatment has been life-altering for many patients, and 93% are seizure free one year after laser ablation surgery at Texas Children’s Hospital.
- How can I determine if my child is a candidate?
- What testing is needed before MRI-guided laser ablation surgery?
- How is the surgery performed?
- What are the results?
- What are the benefits of minimally invasive neurosurgery?
The first step in determining if a patient is a candidate for laser ablation neurosurgery is a careful review of the patient’s medical records, including MRI of the brain and any applicable neurology or neurosurgery records.
MRI-guided laser surgery successfully treats a variety of brain abnormalities including hypothalamic hamartoma, tuberous sclerosis, mesial temporal lobe epilepsy and cortical dysplasia. It can also be used to perform corpus callosotomy.
Every patient’s case is handled individually, and it may be necessary for patients to visit Texas Children’s Hospital for additional testing to determine if they are candidates for MRI-guided laser ablation.
If you would like to speak with someone at the Epilepsy Center to learn more about submitting a patient for consideration, please contact 832-822-0959.
Before laser ablation surgery, an EEG will be performed to capture seizure activity. Some patients may need an overnight EEG, which requires an inpatient stay in the epilepsy monitoring unit (EMU). Special imaging of the brain is completed including an MRI scan, PET scan and resting-state functional MRI scan. As imaging protocols can vary widely between institutions, these tests must be obtained at Texas Children’s Hospital.
In addition, all patients are required to undergo a thorough evaluation with a neuropsychologist prior to surgery. In nonverbal children or children under 3, a developmental evaluation is ordered. Families who are traveling from out of state or outside of the U.S. should have neuropsychological testing completed locally prior to arriving at Texas Children’s for surgery. Appointments with an epileptologist (a neurologist who specializes in the treatment of epilepsy) and a neurosurgeon will also be arranged prior to surgery.
MRI-guided laser surgery targets abnormal brain tissue at the speed of slight and with extraordinary precision. Patients typically spend six to eight hours under general anesthesia, although the majority of this time is surgical planning and MRI scanning after the laser applicator is placed. The actual ablation itself, when the laser is turned on, only takes minutes.
The basic steps of the procedure include:
- The patient will be admitted into an operating room and placed under general anesthesia.
- A head frame is positioned around the patient’s skull with a set of markers to best guide the surgeon on a safe path.
- A CT scan is then taken to orient the brain to the frame in three dimensions. The MR and CT images are studied by the neurosurgeon to determine the exact location of the tissue to be dissolved.
- With the help of computer software, a safe path through the brain is calculated and mapped out.
- After confirming the route to the lesion, the neurosurgeon makes an incision and drills a small hole through the skull, only 3.2 millimeters wide, approximately the diameter of a pencil.
- The laser applicator, a tube about the width of a strand of spaghetti is inserted and guided through the brain into the diseased area. Once inserted into the brain, the head frame is removed and the patient is transported to the MRI scanner.
- After confirming proper placement of the laser applicator, the surgeon performs a small test firing. Once the accuracy is confirmed, the laser is heated to destroy the diseased tissue. Once completed the applicator is taken out and the scalp is closed with a single stitch.
- The patient is then brought to a recovery room for one night and typically goes home the next day.
Throughout a patient’s surgery, the family will stay in the surgical waiting room and will be updated regularly by the operating room patient care liaisons.
Currently, 93% of patients are seizure free one year after MRI-guided laser ablation surgery at Texas Children’s Hospital.
This procedure is proven to be a safer, significantly less-invasive alternative to a craniotomy, which was the traditional technique used for the surgical treatment of epilepsy. Patients are also able to keep their hair, as no shaving is required to perform the surgery.
For the majority of patients who receive the surgery, recovery is minimal. The opening on the scalp is closed with one suture and most patients are released the day after surgery with little to no pain. Most children return to school within a few days after having the surgery.