Laser Ablation – Putting the Heat on Epilepsy, Part 1

Drs. Sharan and Evans in the OR

Drs. Sharan and Evans in the OR

First neurosurgeons Ashwini D. Sharan, MD, and James J. Evans, MD, drilled a hole the size of a pen tip in Nancy’s skull.

Then the two neurosurgeons threaded a fiber-optic laser probe through the small hole into the 43-year-old woman’s brain.  Guided by real-time magnetic resonance thermal imaging, the physicians safely burned out part of Nancy’s hippocampus.

Satisfied with what their monitor was showing, they removed the probe and closed the wound with a single staple.

Nancy, who experienced seizures through-out her life but only received an epilepsy diagnosis at age 27, went home the day after her procedure and hasn’t had a seizure since.

Physicians have treated certain cancers with laser ablation, a technology that uses light energy to destroy tumors or other damaged tissue, for several years, but its use with epilepsy is a newer application.

Jefferson began offering the procedure in fall 2011, and results have been promising.

“All of the [Jefferson ablation] patients have seen improvement, and so far, several have stopped having seizures altogether,” says Dr. Sharan, director of the Division of Functional Neurosurgery at Jefferson. “Until recently, we thought surgical treatment for epilepsy meant we had to open up the skull. But you know what? We don’t.”
Who’s a Candidate?

Nancy is one of the more than 3 million Americans with epilepsy. Not all of them qualify for laser ablation.

Candidates must have tried, without success, a combination of medications. They must also have focal epilepsy, meaning their seizures come from a single, isolated area in the brain.

SuB13-Laser-Ablation-Scan-1“That’s the million-dollar question: Can we identify an exact target to ablate?” Dr. Sharan says.

Neurologist Michael R. Sperling, MD, director of the Jefferson Comprehensive Epilepsy Center, says that while physicians are still learning how effective ablation is and how best to use it, he is most hopeful about the procedure for people who have seizures that start deep in the temporal lobe, in the hippocampus.

“I’m also enthusiastic about ablation for patients whose seizures are triggered by heterotopic lesions next to the ventricles,” Dr. Sperling says. “You really can’t do open surgery on these individuals, as you’d have to dig too far through healthy tissue. The laser presents an elegant way of fixing that problem.”

A ‘Symphony’ of Personnel

An approach that requires well orchestrated teamwork “that Jefferson excels in coordinating,” says Dr. Sharan.

In addition to the standard complement of neurosurgical nursing staff, ablation technology experts attend each procedure to assist with the equipment.

And because images are interpreted in real time and information from multiple scans is combined to construct the brain three dimensionally, both MRI technicians and neuroradiologists also participate in these procedures.

Moreover, a dedicated anesthesia team is always present, and to date, two neurosurgeons have collaborated on every case.

“This procedure is still so new and rare,” says Dr. Evans, who has worked side-by-side with Dr. Sharan during each ablation at Jefferson. “It would be impossible to remember each detail and reproduce each one the same way every time, so we double up to retain as many of the nuances as possible,”

Not every institution can assemble the requisite “symphony of personnel,” Dr. Sharan says. “Ablation is an amazing tool, but it could be slow to catch on because many hospitals simply don’t have the resources.”

For more information on laser ablation for epilepsy read “Setting Ablation Standards – Putting the Heat on Epilepsy, Part 2.”

Reprinted from the Summer 2013 issue of the Jefferson Alumni Bulletin

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