The latest advancement in the treatment of pediatric epilepsy
"Roughly 3 million people are living with epilepsy in the United States today and 150,000 new epilepsy diagnoses are made each year. Next to headaches, seizures are the most common neurologic event, but still nobody talks about it. We're going to change that." — Angus A. Wilfong, MD, Associate Director, Division Chief of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's
Laser ablation surgery is the latest advancement in the treatment of pediatric epilepsy. Phoenix Children's is the only pediatric hospital in Arizona and the Southwest, and one of only a handful of centers in the country, offering laser ablation for pediatric epilepsy and brain tumors.
Laser ablation removes tumors and other lesions through the use of light to heat and destroy unwanted cells. It’s that precision that makes this type of surgery perfect for treating hypothalamic hamartomas—rare, benign tumors of the hypothalamus, a region of the brain that regulates many critical functions. Historically, doctors have used laser ablation to treat conditions in other parts of the body, but thanks to recent advances, neurosurgeons are now using this treatment in the brain.
With new technology from Visualase, doctors use MRI (magnetic resonance imaging) to place a thin laser probe in the brain and perform the surgery. On high resolution monitors, they see precisely what area is being heated and how much, making this treatment pinpoint accurate.
For laser ablation surgery, your child is placed under general anesthesia, will not feel any pain, and will not move, which is important for the treatment to be precise.
A frame is then 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, 1.65 millimeters (in diameter) flexible tube about as wide as a pencil lead. It holds clear fibers that emit light.
The surgeon makes a small incision (3.2 millimeters) in the scalp. The small entry point means most patients have little or no hair removed. The surgeon then makes a small hole the same size in the skull and inserts the probe. The probe’s pathway made through your child’s brain is very narrow and is much less likely to cause damage that could affect brain function.
After probe insertion, the surgical team 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. MRI guidance allows surgeons to position the probe in the exact spot within a millimeter tolerance applying heat only to the lesion and protecting healthy surrounding tissue.
The surgeon then turns on the laser. Light comes out of the tip of the probe and the monitors show precisely where and how warm the tissue is getting. From this, the surgeon can judge how much laser treatment is needed.
When the laser treatment is complete, the surgeon removes the probe and closes the incision typically with a one-stitch suture. Amazingly, the treatment itself, when the laser is on, takes only a few minutes. The careful set-up and mapping the pathway to the affected area before treatment takes longer. The total time under anesthesia is about four hours.
Three Key Advantages
There are three key advantages to the precision of laser ablation surgery at Barrow Neurological Institute at Phoenix Children’s:
- As the only center in the world with the capacity to provide resting-state MRI to isolate a lesion, we have unmatched precision in identifying the affected area to treat
- Precision in mapping the best possible pathway to the lesion to minimize contact with healthy parts of the brain
- Precision in treating the actual lesion as the laser heats only the targeted area, significantly reducing negative impacts on brain functions (vision, movement, memory, language, learning, etc.)
Multidisciplinary Team Provides Treatment for Hypothalamic Hamartoma
In summary, like all surgery, laser ablation is not without 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. Our team will talk with you about the risks for your child.
The results can also 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 could take up to a year to know the full results because the brain requires time to heal after surgery.
Additionally, children who have undergone laser ablation surgery may still have open surgery at a later date if laser ablation surgery failed to cure their lesion.