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.

Neurosurgeons use MRI (magnetic resonance imaging) to place a thin laser probe in the brain and do the surgery. The computer screen shows exactly what area is being heated and how much. This makes the treatment very precise.

Laser ablation surgery is safer and more precise than traditional surgery, with fewer side effects. In traditional open surgery, the surgeon opens the skull and removes tissue. If the lesions are deep in the brain, it may not be possible to do traditional surgery.

What’s special about laser ablation surgery at Seattle Children’s?

Seattle Children’s is among the few children’s hospitals in the country that offer laser ablation for epilepsy and brain tumors. Neurosurgeons and doctors from our Epilepsy Program work together to provide this minimally invasive procedure.

  • One of the most experienced teams in the country will perform your child’s laser ablation surgery. Dr. Jeffrey Ojemann, our Neurosurgery chief, has been performing laser ablation since 2013. Seattle Children’s was among the first in the nation to offer this treatment. More cases mean greater surgical expertise and a sharper ability to determine if surgery is even needed – and that adds up to better outcomes.

  • Treatment decisions for epilepsy and brain lesions are complex. We look at your whole child. First, your child will have tests and imaging studies to find out more about their seizures or tumor.

    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, our team will explain:

    • If laser ablation is an option
    • If it’s a better option than traditional surgery
    • If we recommend it for your child and why

    • Seattle Children’s neurology and neurosurgery programs were ranked #1 in the Northwest in 2017 by U.S. News & World Report. We are consistently ranked among the nation’s best neurosciences programs.
    • Our Epilepsy Program is the only program in the Northwest for children that is accredited level 4 by the National Association of Epilepsy Centers (NAEC). A level 4 center uses the most advanced technology to diagnose epilepsy and evaluate patients before surgery. Only level 4 centers perform a broad range of complex surgeries to treat epilepsy.
    • We are the largest brain tumor center for children in the Northwest and among the nation’s busiest centers.

  • Seattle Children’s doctors lead research in the lab and with patients to improve treatment and quality of life for children with epilepsy and brain tumors. Our patients have the option to take part in research studies of promising new treatments. These are called clinical trials. They can be especially relevant if your child’s disorder is not well controlled with standard medicines or surgeries.

    Our studies include:

    • Identifying which patients are most likely to benefit from laser ablation
    • Using fMRI (functional magnetic resonance imaging) to make surgery for seizures and brain tumors safer and more effective
    • Testing Tumor Paint as a way to help surgeons remove as much cancer as possible while sparing healthy brain tissue

    Experts from Seattle Children’s often present research findings at national conferences, including the American Epilepsy Society’s annual meeting. We are leaders in research groups such as Children’s Oncology Group (COG) and Pacific Pediatric Neuro-Oncology Consortium (PNOC).

    Learn more about Seattle Children’s research and clinical trials.

Who can benefit from laser ablation surgery?

Laser ablation may be a good choice, and even a cure, for children with brain tumors or abnormal tissue that causes seizures. If the damaged area is deep in the brain, these children may have no other treatment options.

Doctors recommend laser ablation for epilepsy or brain tumors only after they learn:

  • If other treatments, like antiseizure medicines, have been tried and failed.
  • Where the lesion is.
  • Its size. Laser ablation surgery works best on small lesions because the tip of the probe heats a small area.
  • The area where seizures start if your child has epilepsy. If doctors can’t identify this area, other treatments may help.
  • Whether other options are riskier. For example, some lesions are deep and hard to reach with traditional open brain surgery.

Your child may benefit from laser ablation if they have a tumor deep in the brain or have epilepsy from:

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

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.

To find out if laser ablation may be an option for your child, contact the Neurosciences Center at 206-987-2016.

Read how laser ablation changed Dana’s life.

What happens during laser ablation surgery?

  • Your child will take medicines that make them fall asleep (general anesthesia). They will not feel any pain and will not move. This is important for the treatment to be precise.
  • We place a frame around your child’s head to help the surgeon insert a probe in the best place to reach the lesion. The probe is a very thin, flexible tube that sends out light. The tube is about as wide as a toothpick.
  • The surgeon makes a small cut (incision) in your child’s scalp just a little wider than the probe. After making a hole the same size in the skull, the surgeon puts the probe into your child’s skull.
  • We move your child into the MRI scanner. Using the MRI display, the surgeon checks the precise placement of the tip of the probe in your child’s brain.
  • The surgeon turns on the laser. Light comes out of the tip of the probe.
  • The computer display shows where tissue is being heated and how warm it is getting. This helps the surgeon decide how much treatment to give and when to stop.
  • The surgeon removes the probe and closes the incision with 1 stitch.
  • The treatment with the laser takes only a few minutes. The careful setup before treatment takes longer. The total time under anesthesia is about 4 hours.

  • 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 different from gamma knife radiosurgery, which uses beams of radiation aimed at the lesion from outside the body.

What are the benefits and risks of laser ablation?

  • Likely benefits of laser ablation for deep tumors and 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. 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. Because it’s more precise, laser ablation is less likely to harm 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 3 days or a week after open surgery.

  • Like all surgery, laser ablation has some risks, such as the chance of infection. There may be some chance of affecting a healthy part of your child’s brain. This depends, in part, on where the 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 doesn’t cure their disorder.

  • The results can vary. For children with brain tumors or other lesions, this treatment may be a cure.

    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 be sure the procedure worked. In some patients, seizures stop for a while but then come back.

Contact Us

For more information, contact the Neurosciences Center at 206-987-2016.

Schedule an appointment

  • To make an appointment, you can call us directly at 206-987-2016 or get a referral from your child’s primary care provider.
  • We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children's.
  • How to schedule an appointment at Seattle Children’s.
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