Texas Children's Hospital uses new surgical approach for treating epilepsy

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 utilizes 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 3.2 mm (about the diameter of a pen) 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.

More than three million people in the U.S. are affected by epilepsy, including about 300,000 children under the age of 14. Uncontrollable seizures can affect a child's memory, concentration, motor skills, school performance and quality of life.  Drug therapies control seizures in about 60 percent of those with epilepsy. Invasive craniotomy, nerve stimulation and special diets are treatment options for patients who do not respond to medication.

"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 Dr. Angus Wilfong, director of Texas Children's comprehensive epilepsy program and associate professor of pediatrics and neurology at Baylor College of Medicine.

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

Five surgeries using this MRI-guided laser procedure have been successfully performed at Texas Children's Hospital on pediatric 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 pediatric epilepsy patients at the Blue Bird Circle Clinic for Pediatric Neurology at Texas Children's Hospital.

Changing the life of a young patient

A recent example of the effectiveness of this new surgery is nine-year-old Texas Children's Hospital patient Keagan Dysart, of Converse, Texas, who suffered from two types of epileptic seizures when he was diagnosed with a hypothalamic hamartoma in his brain. The gelastic seizure caused him to giggle and laugh uncontrollably two or three times an hour.  Keagan would also periodically experience a tonic seizure, with generalized body stiffening and loss of awareness that caused him to fall asleep for sometimes up to an hour afterward.  Keagan's case was particularly high risk because his lesion was located in the hypothalamus, near the brain stem. In this highly sensitive region, there are a myriad of potentially serious complications from surgery including loss of sight, damage to the pituitary gland, stroke from artery damage or development of diabetes insipidus (DI), a potentially fatal condition where the kidneys are unable to conserve water because of disruption to the area of the brain that releases the body's anti-diuretic hormone.  

The location, size and complexity of Keagan's brain lesion made him an ideal candidate for the new surgical procedure, which was successfully performed in March without any surgical complications.  He is now seizure-free.  

"Knowing the complexity of Keagan's case, the decision to go forward with this surgery was the toughest decision and the best decision we ever made," said Khris Dysart, Keagan's father.