MRI-guided Laser Thermal Ablation

Any patient with medically refractory epilepsy and MRI-visible lesions like an HH, are potential candidates for laser thermal ablation therapy. Laser ablation is performed through a small ‘nick’ scalp incision and hole in the skull as opposed to an extensive scalp incisions and large cranial opening that is typical of standard epilepsy surgery. The treatment time and recovery time are both dramatically faster. In the event that the procedure incompletely treats a patient’s epilepsy, repeat treatments are usually straightforward and well- tolerated. Although thermal ablation is a minimally invasive surgery, there are risks. Treatment success is completely dependent on accurate placement of the laser fiber into the target lesion. Inaccurate placement of the laser is a potential risk and therefore injury to fragile or sensitive structures nearby is possible. For that reason, the majority of the treatment time is meant to ensure the accuracy of laser placement prior to initiating ablation. As with any brain procedure, there are risks of bleeding and infection, but these are always proportional to the size of the surgical exposure, treatment time and depth of treatment, all of which are lessened with laser therapy compared to open cranial surgery. The actual laser ablation treatment time is on the order of minutes. Set-up time and laser fiber placement can be 3-4 hours. The majority of patients spend one night in the hospital and are discharged the following day.