MRI-guided laser procedure may offer alternative to epilepsy surgery

3 June 2014

A minimally invasive laser procedure performed under MRI guidance could provide an effective alternative to surgery for patients with mesial temporal lobe epilepsy (MTLE) that can't be controlled by medications, a new US study has found.

In the June issue of Neurosurgery, researchers led by Dr Robert E Gross of the Emory University School of Medicine in Atlanta report their experience with MRI-guided SLAH in 13 adult patients with epilepsy mapped to a part of the brain called the mesial temporal lobe. The patients, median age 24 years, had "intractable" seizures despite treatment with antiepileptic drugs, reports Science Daily.

In the SLAH procedure, a saline-cooled fiberoptic laser probe was precisely targeted to the area of the brain - the "amygdalohippocampal complex" - responsible for the procedures. Using real-time MRI guidance, the neurosurgeon was able to pinpoint the area of the brain responsible for seizure activity and destroy (ablate) by computer-controlled laser energy, without harming neighbouring brain tissue.

On average, 60% of the amygdalohippocampal complex was destroyed. Median time spent in the hospital was just one day, compared to a typical two to five-day stay after conventional temporal lobe surgery, and SLAH patients did not have to be admitted to the intensive care unit.

Most important, the procedure was effective in reducing or eliminating seizures in patients with MTLE. At a median of 14 months after SLAH, ten out of 13 patients achieved meaningful seizure reductions, while seven were free of "disabling seizures".

"Such minimally invasive techniques may be more desirable to patients and result in increased use of epilepsy surgery among the large number of medically intractable epilepsy patients," Dr Gross and colleagues conclude.



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