“The results of laser ablation to treat inoperable brain tumours, epilepsy and refractory cancer pain are very exciting,” Shabbar F Danish, director, Stereotactic and Functional Neurosurgery and assistant professor at Rutgers-Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, New Brunswick, USA, told NeuroNews.
What are the preliminary results of laser ablation performed on patients at Robert Wood Johnson?
We have performed over 100 laser procedures to date. The preliminary results are very exciting as we are able to achieve outcomes similar to open procedures without the side-effects of an open procedure in many types of cases.
What is the evidence in the literature for use of laser ablation for epilepsy?
Ablation techniques have been used to treat brain tumours for many years, starting in the late 1980s. The use for epilepsy is fairly new, being introduced in 2010. We are just starting to see this data in the literature for epilepsy. This year will mark the beginning of the first national multicentre trial to understand the efficacy of laser therapy in the treatment of temporal lobe epilepsy.
Alternative treatments for brain tumour patients include chemotherapies, radiation therapies, and open surgery. The traditional treatment for refractory epilepsy involves an open craniotomy. This procedure aims to achieve the same outcome without having the patients undergo an open operation.
What improvements do patients see after the procedure?
It depends on the type of disease being treated. For patients with brain tumours, we are able to get the tumours to stop growing. For epilepsy patients, we are able to cure their seizures and patients become seizure free. There are some tumours that we have been able to cure, and others that require a repeat treatment to keep them under control. Tumour growth is monitored with close imaging, and recurrence is objectified via analysis by a multidisciplinary neuro-oncology board. Outcomes for epilepsy patients are monitored using the Engel classification system. Patients treated for refractory pain syndromes are monitored using the brief pain inventory (BPI)-short form.
What type of patient is the suitable candidate for laser ablation?
Patients diagnosed with any type of brain tumour who have been told they do not have other options, patients with epilepsy that has not responded to medications, and patients with cancer-related pain may be candidates for laser ablation. In addition, patients who have had CyberKnife or gamma knife surgery for a brain tumour that then grows back are very good candidates for this therapy.
What are the complications associated with laser ablation?
Complications associated with the procedure include a 1% risk of haemorrhage or stroke. There is a 2–5% chance that the laser is not placed in an optimal position and there is a risk that the tumour or epilepsy focus is not completely ablated. In the latter case, the procedure can be repeated.
What is your message to other neurointerventionists?
I think that it is important to consider a minimally invasive option when it exists. The open or more risky alternative is always an option, but as we have learned from other specialties in medicine, if we can achieve the same outcomes with a minimally invasive procedure, why would we not take that approach?
Do you involve other specialties in case selection?
We approach all patients through a multidisciplinary board and when this approach is not appropriate will recommend alternative strategies. We believe that all patients and physicians should be educated about all the options that exist, especially if one is available that affords the patients less morbidity from the procedure.