For patients who don’t respond to medications to control their epilepsy, their surgical options previously were limited to a lengthy, invasive craniotomy for resection. But a relatively new minimally invasive procedure called laser ablation uses an MRI-guided laser to pinpoint and treat highly targeted areas of the brain that are causing seizures.
Patients with epilepsy often endure years or even decades of uncontrolled seizures; up to 30% of them may be refractory to medical therapy. In addition to experiencing a reduced quality of life, patients with refractory epilepsy require 4-9 times as much health care as those with well-controlled epilepsy.
How laser ablation works
Laser ablation is highly tailored to meet each individual patient’s needs. For appropriate candidates for the procedure, it can lead to seizure control in 60% of patients with epilepsy that is uncontrolled by medications.
The procedure is performed in an intraoperative MRI suite and uses a precisely placed fiber optic cable to deliver targeted heat to destroy the portion of a patient’s brain causing the seizures. An MRI is done to determine the exact area to be ablated while also allowing the medical team to monitor the brain’s temperature. After making a minimal incision in the scalp, the surgeon drills a 5-millimeter hole in the skull, allowing a small catheter to be guided to the target area.
Laser ablation heats and destroys the targeted area, and then the incision is closed with a single stitch. In general, the entire procedure usually takes about four or five hours, and the patient typically is hospitalized less than 24 hours. In contrast, a craniotomy typically requires multiple days in the hospital after surgery, usually causes more pain, and has more associated risk of infection and other postoperative complications.
Case studies using laser ablation
Lesion (dysplasia) within the amygdala: A 38-year-old man had epilepsy that was well controlled for several years. But during the last six months, he had frequent seizures (every one to two days) despite increasing medication doses. After being treated with laser ablation, the patient was neurologically intact, was discharged after two days, continued his medication regimen for several months, returned to work and has had no seizures since May 2018.
For mesial temporal sclerosis: A 56-year-old woman had experienced seizures once or twice a week for 30 years, despite trying at least seven anticonvulsants. After laser ablation, she had a minimal headache, was neurologically intact, spent one day in the hospital, continued her medications for several months before weaning, and has had no seizures since June 2018.
For more information
Laser ablation and other treatment options for epilepsy are provided by the multidisciplinary team of experts at Providence Brain and Spine Institute and The Oregon Clinic.
Providence St. Vincent: 9205 SW Barnes Road, Portland, OR 97225
The Oregon Clinic Neurosurgery: 9155 SW Barnes Rd., Suite 440, Portland, OR 97225
Seth F. Oliveria, M.D., Ph.D., director, Functional Neurosurgery, Providence Brain and Spine Institute; The Oregon Clinic Neurosurgery
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