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.