Using an MRI-guided laser beam to remove epilepsy-related brain tissue is safer, quicker, and more successful than conventional surgery, according to Wake Forest Baptist Medical Center in North Carolina.
Neurosurgeons there have had a 75% success rate in treating epilepsy with MRI-guided laser ablation — or tissue removal — since they introduced it in 2012. The brain tissue they target is drug-resistant, so removing it is the only option.
Epilepsy causes seizures — sudden episodes of altered or diminished consciousness, involuntary movements or convulsions. This can severely limit a patient’s daily activity and lead to serious physical and cognitive problems.
For the roughly 40 percent of patients with epilepsy who do not respond to prescription drugs, including many with a special kind of epilepsy called medial temporal lobe epilepsy (MTLE), surgery is often the only option.
MRI-guided laser ablation uses a computerized brain imaging system to guide a laser to precisely the point in the brain where diseased tissue is, helping doctors to destroy it.
It has many advantages over conventional surgery for therapy-resistant epilepsy.
To start with, its success rate is higher. Neurosurgeons performed the first MRI-guided laser ablation surgery for epilepsy at Wake Forest Baptist five years ago, using a technology called Visualase. It helped them achieve a success rate of 75 percent, compared with 60 percent for conventional surgery.
In fact, Visualase technology has replaced conventional surgery for treating epilepsy at the medical center.
Another advantage of laser ablation is less impact on the skull. Conventional epilepsy surgery involves removing part of a skull, a procedure called craniotomy. Laser ablation involves making a tiny hole in the skull that a laser can be shined through to destroy the problem tissue.
Craniotomy is a day-long surgery followed by a week in a hospital and a long recovery period, whereas MRI-guided laser ablation can be done in four hours, with release from hospital the next day. Ablation patients can also resume normal activities almost immediately.
“The patient is not excessively inconvenienced or placed at extraordinary risk to get relief from their seizures,” Dr. Gautam “Vinnie” Popli, chief of the medical center’s epilepsy center, said in a news release. “There’s much less collateral damage and fewer adverse effects than conventional surgery, and better outcomes.”
“It’s a game-changer,” Popli said. “This type of surgery allows us to precisely target areas of seizure without added risk, and there’s a very short recovery time.”
“When I was having the seizures I was a different person than I was before. I was isolated, and felt as if I was a burden on everyone, especially my parents, “Melanie Vandyke, one of the first patients to have laser ablation at Wake Forest, said. “But now I’ve regained my independence. I’m back to being the old me, and thankful for that.”