Laser Ablation

Introduction

Laser Ablation is a surgical treatment used to treat tumors and other lesions. The surgeon uses light to heat and removes unwanted cells during this process. Laser ablation surgery is beneficial, safe, and more accurate than traditional surgical methods with minimal side effects. In traditional surgical procedures, the surgeon opens the skull and removes the unwanted tissues. If the lesions are deep in the skin, removing the brain from the traditional surgery method is difficult or impossible. Laser ablation surgery is also known by many other names, such as stereotactic laser ablation, Real-time MRI-guided laser ablation surgery, and thermal ablation or thermoablation.

Causes of laser ablation surgery

The doctor will suggest laser ablation for a brain tumor or epilepsy in the following situations:

• If the other treatment, like antiseizure medicines, are tried and failed
• After finding out the location of the lesion
• After they find out the size of the lesion because laser surgery works best on the small lesions
• If they find out the area where seizures start in case of epilepsy
• When the lesions are deep in the brain, and it is difficult to reach them with traditional open brain surgery

Who takes benefits from laser ablation surgery?

Laser ablation is highly beneficial in epilepsy and complex brain lesion. If the affected area is deep in the patient’s brain, then laser ablation is the best option to treat tumors or abnormal tissues in the brain. Patients get benefits from laser ablation surgery when they have deep brain tumors and epilepsy from:

• Hippocampal sclerosis, which is the reason behind temporal epilepsy
• Hypothalamic hamartoma
• Tuberous sclerosis
• Focal cortical dysplasia in rare cases

There is no age limit for laser ablation, but the youngest patient who gets laser ablation is about two years old. The physician will decide all treatment options after complete diagnosis and testing.

Laser ablation surgery procedure:

• Firstly a medicine known as general anesthesia is given to the patient, which makes him fall asleep. General anesthesia is provided so the patient wouldn’t move and feel any pain during this process.
• ROSA brain is used as an advanced surgical tool, which helps the surgeon insert a probe and reach its best place. A probe is a thin, flexible tube just the size of a toothpick that sends laser light during surgery.
• For surgery, the surgeon made a small cut on the patient’s scalp, which is a bit wider in size than the probe.
• After the incision, the surgeon puts the probe in the patient’s skull.
• The patient is moved into an MRI scanner, and with the help of an MRI display, the surgeon checks the accurate placement of the probe’s tip in the patient’s brain.
• After that surgeon turned on the laser and heated the tissues with the help of light coming from the probe’s tip
• The MRI display shows how the tissues are heating and how warm it is getting.
• The surgeon removes the excessive tissues with the help of a probe.
• The surgeon knows how much treatment is required and when to stop. After completion, he removes the probe and closes the cut with one stitch.
• It takes a few minutes to give treatment through laser, but the setup takes time. The patient usually spends 3 to 4 hours under anesthesia even after treatment.

Results:

Laser ablation results vary from person to person and situation to situation. It is highly beneficial to patients suffering from brain tumors and other lesions. In epilepsy cases, 50% of patients become seizure-free after a few weeks of the treatment. The success rate is the same even in open surgery, but this process has fewer risks and side effects. In the remaining 50% of cases, the patients might not be recovered fully, but the conditions of the patient might be improved. The seizures of the patients turn less severe and happen less than before. It takes a year to make sure that either the procedures have worked or not because, in some cases, it is noticed that seizures stop just after treatment, and then it comes back after some time.

Benefits:

Some of the benefits of laser ablation are the following:

• Less harmful:

The process is less harmful than open surgery because the path used in laser ablation is narrow compared to open surgery, causing less damage to the brain and scalp.

• More precise treatment:

In laser ablation, MRI guidance is used to get the probe at the exact treatment spot. The treatment is accurate, and it only heats out the lesions. Because of the accuracy of the treatment, this treatment is highly beneficial because there is a minimal chance that laser ablation harms the patient’s memory, vision, learning, movement, language, and other brain functions.

• Easier for the patients:

This process is easier for the patient because of the short time for the laser and the small entry point. In open surgery, the patient is allowed to go home after three days or a week, but in laser ablation patient immediately gets back home after surgery.

Risks:

Just like many other surgical procedures, laser ablation also has some risks in it, and there is a chance of infection in the patient body after treatment. There are also some chances that the healthy part of the patient’s brain gets affected due to laser ablation, but it usually depends on the location of the lesion. Your surgeon will discuss the risks and benefits of this surgery before the process. In some cases, when the condition does not cure through laser ablation, open surgery is recommended even after undergoing laser ablation.

References:

• https://www.seattlechildrens.org/clinics/neurosciences/services/laser-ablation-surgery-epilepsy-brain-tumors/
• https://www.neurosurgery.columbia.edu/patient-care/treatments/laser-ablation
• https://www.brainrecoveryproject.org/brain-surgeries-to-stop-seizures/what-is-laser-ablation/