Texas Children’s Hospital pioneers use of MRI-guided laser surgery to treat epilepsy

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Texas Children’s Hospital is the first hospital in the world to use real-time MRI-guided thermal imaging and laser technology to destroy lesions in the brain that cause epilepsy and uncontrollable seizures.

According to hospital experts, this new surgical approach offers a safer and significantly less invasive alternative to craniotomy, currently the most commonly used cranial surgical treatment for epilepsy. For high-risk patients with deep brain lesions, this new technique can be particularly life-changing because the MRI-guided laser probe utilises a much smaller pathway through the brain to reach a deep lesion. This reduces the risk of patient complications related to contact with surrounding brain tissue. In addition, the MRI-guided laser probe is inserted through a hole in the skull that is only 3.2mm versus the removal of a larger area of skull bone for a craniotomy. Because it is a less invasive procedure, patient recovery time is much shorter.


“Based on our experience, we believe the use of MRI-guided laser surgery will change the face of epilepsy treatment and provide a life-changing option for many epilepsy surgery candidates — both children and adults,” said Angus Wilfong, director of Texas Children’s comprehensive epilepsy programme and associate professor of paediatrics and neurology at Baylor College of Medicine.


The first surgeries were performed by Wilfong and Daniel Curry, Texas Children’s director of paediatric surgical epilepsy and functional neurosurgery and assistant professor of neurological surgery at Baylor College of Medicine.

Five surgeries using this MRI-guided laser procedure have been successfully performed at Texas Children’s Hospital on paediatric epilepsy patients ranging in age from five to 15 years old, with widely varied types of brain lesions. In all cases, patients have been seizure-free since surgery and most were released within one to five days.


“While we have been successful in curing epilepsy through open cranial surgery for quite some time, the benefits of this new approach in reducing risk and invasiveness while providing instant therapeutic effect may open the door for more epilepsy patients to see surgery as a viable option,” said Curry.


The surgery is performed by first mapping the area of the brain where the lesion is located using magnetic resonance imaging. The catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures.


Wilfong noted that MRI-guided laser surgery has been successfully used in treating brain tumors and that he and Curry saw that its same attributes would apply to deep seated epilepsy-causing lesions. The neurologist and neurosurgeon introduced a first-of-its-kind trial of the treatment to paediatric epilepsy patients at the Blue Bird Circle Clinic for Pediatric Neurology at Texas Children’s Hospital.

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