A Less Invasive Route to Being Seizure-Free: Stereotactic Laser Ablation

Описание: Drs Andrew Wilner and Robert Gross discuss a minimally invasive approach to treating mesial temporal lobe epilepsy and how its efficacy compares with surgery.
https://www.medscape.com/viewarticle/...

-TRANSCRIPT-
Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner, and I'm here today with Dr Robert Gross. Dr Gross is a neurosurgeon and holds the Henry Rutgers Chair at Robert Wood Johnson and New Jersey Medical School at Rutgers.

Dr Gross recently presented his research at the American Epilepsy Society meeting. His abstract was titled, “Stereotactic Laser Ablation for Mesial Temporal Lobe Epilepsy (SLATE) Study: A Prospective, Single-arm, Multicenter Study.”

Welcome, Dr Robert Gross.

Robert Gross, MD, PhD: Thank you. My pleasure to be here.

Epilepsy Surgery vs Laser Ablation
Wilner: Just to set the stage, we know that epilepsy surgery is really the definitive treatment for people with intractable epilepsy who have failed all the medications, and that surgery will be best. There's still the question of which type of surgery. Where does laser ablation fit in?

Gross: All of the surgeries that we do for epilepsy, save neuromodulation therapies, are destructive surgeries. They involve removing a section of the brain that is our so-called epileptogenic focus, disconnecting part of the brain or removing a large area like a hemispherectomy.

The goal of epilepsy surgery, for the most part, is to remove the hotspot or the epileptogenic zone. We've been doing this for a century by opening up the skin and the cranium, and physically getting down to the brain and actually removing that section of the brain.

I would call that maximally invasive surgery. It's painful. It's long. The recovery from it takes a bit of time. You're out of work for a while and there are complications associated with it.

For years, we've been attempting to find a more minimally invasive corridor into the brain to do exactly the same thing, to remove that epileptogenic focus. Ultimately, this led to, approximately a decade ago, the advent of a laser technique that is just such a minimally invasive approach where a small laser catheter is introduced into the brain that is about the size of a pen cartridge on your regular ballpoint pen.

Through that catheter, we can pass a fiber optic down into the brain and heat the brain up to the temperature at which it essentially melts in a very discreet area, and guide that with the MRI scan, which actually can show us the heating of the brain so that we can be sure that we're ablating — and that's the word we use for this — exactly the area we need to ablate, no more and no less.

That technique is called stereotactic laser ablation. It also goes by the name LITT, or laser interstitial thermal therapy. That technique is much more minimally invasive, involves less brain destruction, involves not doing an open craniotomy, is quick to recover from and return to work more quickly, and has, in many respects — not all, but many respects — replaced the procedures that we were doing for the last century.

Wilner: Let me recap a little bit. All you have to do is drill a very small hole, put a catheter in, heat it up, and you have MRI. Normally, with MRI, you send the patient, they get it done, and they come back. In this case, you have MRI, which is live in the OR. Is that correct?

Gross: That's correct.

Wilner: You can see what you're doing in terms of following the temperature. I guess when it turns red, it's too hot. Then you're done.

Gross: Yes. It sounds simple. It is a complicated procedure. It involves a different set of techniques than were typically used by an epilepsy surgeon, these so-called stereotactic techniques, where we have to introduce this catheter while not being able to see it directly. We use the MRI scan to be able to see it and to plan how it gets in. We use CT scan as well.

These are called stereotactic techniques, and it involves using a laser in a different way than we've even done for many decades. It's a novel approach. It's complicated, but it's masterable and repeatable. Yes, it leads to patients going home essentially the next day in the vast majority of cases.

Wilner: The question is, is it as good as doing the traditional surgery? What did you find?

Gross: We and others have been using this technique for as long as a decade. Our center has been leading the way with the most cases, but there have been many cases that have been done now across the country and even across into Europe and Canada.

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