Epileptic patients who are candidates for laser treatment
In children the indication for laser epilepsy surgery is quite restricted, but primarily it is for epilepsies with:
- Clearly identified origin of the lesion in the brain.
- The lesion is usually small (approximately 1 cm) or elongated and whose diameter along the entire axis is 1 cm.
- The lesion is located in a deep area.
In summary, this laser ablation technique is used for the treatment of epilepsies that do not respond to medical treatment and have lesions with very specific characteristics, in relation to their morphology.
Very few epileptic patients are treated using the laser technique, although epilepsy is quite common (1% of the population). Of that 1% of the epileptic population, only one third does not respond to pharmacological treatment, i.e., 3 out of 9 patients do not respond, and of those 3 patients who do not respond, 1 of them could be a candidate for surgery, in general. Given this situation, it is easy to deduce that candidates for laser surgery are very few, taking into account the specific characteristics of the lesion.
In the pediatric population, the patients who are the best candidates for this technique are the patients who have a hypothalamic hamartoma, and in fact, these are the patients in whom we have the most success.
Hypothalamic hamartomas are a kind of congenital tumor or malformation that sits in the deepest part of the brain and causes epilepsy that is highly resistant to medication from infancy. Due to its deep location, the approach by open surgery is very complicated and with many risks, so these patients are ideal candidates for laser surgery, because in most cases they are very small lesions that are located in very deep sites and can be seen very well by magnetic resonance imaging.
Development of the intervention of laser treatment for epilepsy
To perform this laser surgery, a catheter with a laser fiber is grafted into the lesion to be treated. The catheter must be placed with great precision, since the lesions to be treated are very small. To perform this delicate placement of the laser fiber in the center of the lesion, a robotic arm is used, which follows a previously traced trajectory. Once the implanted fiber is inserted into the lesion in the patient’s skull, the patient is transferred to the MRI and under control and in real time by MRI, the ablation of the injured tissue is performed. Why perform the intervention through MRI? MRI provides two types of information:
- Temperature: in real time it is observed how the tissue to be ablated is heated.
- Follow-up of the ablation: it is possible to see live how the tissue is being injured.
Once the ablation of the injured tissue is completed, the fiber is removed and a single stitch is placed.
Advantages of laser surgery for epilepsy
The main advantages of the laser technique are:
- Minimally invasive technique: this is the most fundamental advantage.
- Very safe technique: what is being injured is monitored in real time through magnetic resonance imaging.
- Minimal blood loss: due to the low invasiveness of the technique itself. As there is hardly any blood loss, no blood transfusion is required.
- Very fast recovery
- Very good results
Innovation for the treatment of epilepsy
The laser technique is so innovative for two reasons:
- A robotic arm is used for fiber implantation.
- Applied to pediatric patients: currently in Spain there are only two centers that perform this technique and in pediatric patients only I perform it at the Hospital Sant Joan de Deu. At European level it is performed by very few hospitals, since this technique has been approved by the European Union at the beginning of 2019.
Postoperative period after laser surgery
Due to the low invisibility of the technique, recovery is very fast, and the patient is discharged in two or three days. Once discharged, the patient is followed up for 3 to 9 months.
Results of the laser technique for epileptic patients
The results of this technique are spectacular. In the scientific bibliography of other specialists who have been performing this technique for a longer period of time, it is stated:
- Laser technique: 80% effectiveness in controlling epilepsy in hypothalamic hamartomas.
- Endoscopic technique: 60-70% of effectiveness in the control of epilepsy.
- Open surgery: 50% effectiveness in epilepsy control.
From these data it can be seen that the laser technique is much more effective than the techniques previously used.