When children with epilepsy run out of treatment options, MRI-guided laser ablation surgery offers hope for a seizure-free life.
Epilepsy disorders and treatments come in all shapes and sizes. For many, traditional treatments like medication and open surgery are good options to reduce or eliminate seizures caused by the disorder.
For others, particularly those with small, focused lesions deep in the brain, traditional treatments are often ineffective or incredibly risky.
Now, Seattle Children’s offers a new treatment called that gives MRI-guided laser ablation surgery children with limited or no treatment options the chance to live seizure-free lives.
Children’s is the only pediatric hospital in the Pacific Northwest that offers this treatment, which was first introduced at Texas Children’s Hospital. Only a handful of centers in the U.S. offer MRI-guided laser ablation surgery today.
Treatment one millimeter at a time
Laser ablation treatment isn’t new, but the ability to guide the laser using MRI imaging is. The technology, created by Visualase, allows surgeons to treat only the areas of the brain they want to treat, down to the millimeter.
The surgeon makes a small incision, about 3.2 millimeters, to insert the laser probe. With real-time MRI guidance, the surgeon positions the probe at the exact location of the lesion.
Once it’s in the right spot, the laser heats and destroys only the lesion, with minimal to no damage to surrounding brain tissue. The treatment itself takes only about four minutes.
“The MRI scan shows us exactly what area is being treated and at what temperature,” says Dr. Jeffrey Ojemann, director of epilepsy surgery at Children’s. “This ability to peer inside the brain without treating anything other than what we want is a huge advantage.”
Ojemann also performs the surgery on adult patients at Harborview Medical Center in Seattle. “By using this treatment in both places, we’re able to develop this expertise much faster than if it had just been at one place,” says Ojemann.
Helping patients who have no options
Dr. Edward "Rusty" Novotny, head of the Epilepsy Program at Children’s, says MRI-guided laser ablation surgery is frequently the best option for children who have epilepsy due to hypothalamic hamartomas, tumors on a deep part of the brain called the hypothalamus.
When removing these deep lesions with traditional open surgery, the surgeon must create pathways through normal tissue to reach the lesion. That disruption of normal tissue can cause unintended consequences that may result in strokes and other injury, resulting in negative effects on memory, intellectual performance or language.
With laser ablation, the path to reach a deep lesion is very small, which means far less disruption of normal tissue.
“There have been a dozen or so approaches to try to remove tumors in this deep area of the brain, but all have had a fair number of consequences,” says Novotny. “It’s phenomenal how effective laser ablation treatment is and how minimally invasive it is from a surgical standpoint.”
Because the procedure is much less invasive than traditional open surgery, recovery is much faster and patients often go home the day after surgery.
Unlike some other treatments, the results of MRI-guided laser ablation are relatively immediate. That means a patient can be seizure-free within the first week of the procedure.
Treating more tumors
Ojemann says early data suggests about 50% of all patients who receive the treatment become completely seizure-free, which is a similar success rate to open surgery.
As additional studies confirm the efficacy of MRI-guided laser ablation surgery, it may become an increasingly preferred option for many epilepsy cases at Children’s, including those currently treated with traditional surgery.
MRI-guided laser ablation can also be used to remove other types of tumors deep in the brain that are difficult to reach with traditional surgery techniques.
“The technology gives you the precision of always being in the right place, avoiding critical structures, and watching as you deliver the treatment,” says Novotny.
“It’s phenomenal how effective laser ablation treatment is and how minimally invasive it is from a surgical standpoint.”
– Dr. Edward Novotny