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.