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Laser Ablation Surgery for Epilepsy and Brain Tumors

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What is laser ablation surgery?

Laser ablation (LAY-zer ab-LAY-shun) surgery is a treatment to remove tumors and other lesions. It uses light to heat and destroy unwanted cells.

For decades, doctors have used laser ablation to treat conditions in parts of the body other than the brain. Thanks to recent advances, neurosurgeons can now use this treatment in the brain. With new technology from Visualase, doctors use MRI (magnetic resonance imaging) to watch as they place a thin laser probe in the brain and perform the surgery. They use a computer screen to see exactly what area is being heated and how much, which makes this treatment very precise.

Seattle Children’s is the only pediatric hospital in the Pacific Northwest, and one of only a handful of centers in the country, to offer laser ablation for epilepsy and brain tumors. Experts from the Epilepsy Program and Neurosurgery work together to provide this minimally invasive procedure.

Who can benefit from laser ablation surgery?

Laser ablation surgery works best on small tumors and other lesions because the tip of the probe heats a small area.

This procedure can be used on lesions that cause seizures or pose risks to the brain. Laser ablation may be a good choice, and even a cure, for children who have few or no other treatment options, either because medicine doesn’t control their seizures or their lesions are deep and hard to reach with open brain surgery (craniotomy).

Your child may benefit from laser ablation if they have epilepsy from:

  • Hypothalamic hamartoma
  • Hippocampal sclerosis that causes temporal lobe epilepsy
  • Focal cortical dysplasia, in some cases

This treatment may also benefit children with:

  • Tuberous sclerosis, which can cause seizures or other brain problems
  • A deep brain tumor that is growing slowly (low-grade brain tumor)

Doctors recommend laser ablation for epilepsy or brain tumors only after they learn where the lesion is and that other treatments are not working or are more risky. Because it takes time to consider all treatment options, the youngest patients to get laser ablation are about 2 years old. There is no upper age limit.

If the lesion is too large or the cause of the seizures is hard to identify, laser ablation is not a good option, but open surgery may help.

To find out if your child is a candidate:

  • If your child has epilepsy, call the Epilepsy Program at 206-987-2078.
  • If your child has a brain tumor or other lesion without epilepsy, call Neurosurgery at 206-987-2544.

What happens during laser ablation surgery?

Your child will be given medicines that make them fall asleep (general anesthesia). They will not feel any pain and will not move, which is important for the treatment to be precise.

A frame is placed around your child’s head to help the surgeon insert a probe in the best place to reach the lesion. The probe is a thin, flexible tube about as wide as a pencil lead. It holds clear fibers that emit light.

The surgeon makes a small cut (incision) in the scalp about as wide as a coffee stirrer (3.2 millimeters) and then makes a small hole the same size in the skull. After inserting the probe, the surgeon moves your child into the MRI scanner. Using the MRI display, the surgeon confirms the precise placement of the tip of the probe in the brain and then turns on the laser.

Light comes out of the tip of the probe, and the computer display shows where and how warm the tissue is getting. This way, the surgeon can judge how much treatment to give and when to stop. The surgeon removes the probe and closes the incision with one stitch.

The treatment itself, when the laser is on, takes only a few minutes. The careful set-up before treatment takes longer. The total time under anesthesia is about four hours.

 

An Inside Look at Laser Ablation Surgery

Dr. Jeffrey Ojemann explains what happens during minimally invasive MRI-guided laser ablation surgery. Laser ablation surgery is much safer and more precise than other treatments, with fewer side effects.

This method is also called other names, such as:

  • Real-time MRI-guided laser ablation surgery
  • Stereotactic laser ablation
  • Thermal ablation or thermoablation, because it uses heat

Laser ablation surgery is not the same as gamma knife radiosurgery, which uses beams of radiation aimed at the lesion from outside the body.

What are the benefits and risks?

Laser ablation surgery may cure epilepsy for children whose seizures are not controlled with medicine. This treatment may cure other brain tumors or lesions too.

The results can vary. About half of patients with epilepsy become seizure-free, sometimes within a week. This is about the same success rate as with open surgery, but with less risk. Some patients still have seizures, but they are less severe or happen less often. It may take up to a year to know the full results because the brain needs time to heal.

Open surgery, where tissue is removed, may not be the best option – and sometimes it is not an option at all – if the lesions are deep in the brain. Possible benefits of laser ablation for deep lesions include:

  • Less harm to healthy tissue on the way in. With laser ablation, the path through the healthy parts of the brain is very narrow, much smaller than for open surgery. So laser ablation is less likely to cause damage that could affect how your child’s brain works.
  • More precise treatment at the lesion. With MRI guidance, surgeons can get the probe in the exact spot down to the millimeter. This precision helps them apply heat only to the lesion and protect healthy tissue nearby. Because it’s more precise, laser ablation is less likely to have negative impacts on your child’s vision, movement, memory, language, learning and other brain functions.
  • Easier on your child’s body. The small entry point and the short time for the laser treatment are easier on your child’s body. Your child will recover faster and is less likely to have pain. Often, patients go home the day after laser ablation, compared to three days or a week after open surgery.

Read how laser ablation changed Dana’s life.

Like all surgery, laser ablation has some risks, such as the risk of infection. Also, there may be some chance of affecting a healthy part of the brain. This depends, in part, on where the tumor or lesion is located. Your child’s surgeon will talk with you about the risks for your child. 

Children who have laser ablation can still have open surgery later if laser ablation didn’t cure their lesion.

Why choose Seattle Children’s?

Your child’s laser ablation surgery will be performed by one of the most experienced teams in the country. Seattle Children’s was one of the first hospitals in the West to offer this treatment for children with epilepsy and brain tumors.

Dr. Jeffrey G. Ojemann performs laser ablation at Seattle Children’s and at Harborview Medical Center. Performing the surgery at both hospitals has allowed him to develop expertise and experience in children, teens and adults.

Treatment decisions for epilepsy and brain lesions are complex. All children are unique. We look at the whole child. First, your child will have a complete evaluation. This means doing tests and imaging to find out more about your child’s lesion and brain function. With epilepsy, it’s important to tell:

  • What type of seizures your child has
  • What causes the seizures
  • If the doctors can use imaging to identify the lesion

We also talk with you and your child to understand how your child is affected and how other treatments have worked. Taking into account everything we learn about your child, our team will explain whether laser ablation is an option, whether it’s a better option than open surgery and why.

Advancing care with research

Because laser ablation for epilepsy and brain tumors is still fairly new, we are still learning about how laser ablation can help children with epilepsy and brain tumors. Researchers at Seattle Children’s are working with others around the nation on leading studies to learn more. These studies:

  • Refine what we know about who can benefit from laser ablation
  • Help us know what results to expect
  • Help us know how to limit any risks

Experts from Seattle Children’s and other major centers often present current findings at national conferences such as the American Epilepsy Society’s annual meeting. We apply the most current knowledge from research.

How do I get more information or make an appointment?

Call us to make an appointment or find out more about whether your child is a candidate for laser ablation.

  • If your child has epilepsy, call the Epilepsy Program at 206-987-2078.
  • If your child has a brain tumor or other lesion without epilepsy, call Neurosurgery at 206-987-2544.

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