Laser Ablation Brain Surgery - Procedure and Risks

Introduction

Laser ablation is a technology that can use light energy and heat to destroy or remove diseased brain tissue. It is an advanced technology used nowadays and in the near future not only to treat brain tumors but also to treat conditions such as depression and OCD (obsessive cleanliness disorder), which were resistant to all kinds of treatment in the past.

What Is Laser Ablation Surgery?

Laser ablation surgery is one type of surgery that uses heat and light to ablate (destroy) a small part of the brain, causing seizures. It is a procedure that involves minimal invasion and also contains less postoperative pain and lesser recovery time as compared with traditional brain surgery techniques. The incision for laser ablation surgery can be closed with only one stitch, which helps us understand the minimalistic treatment approach.

Who Might Find Laser Ablation Surgery Advantageous?

Laser ablation could be a favorable option, even for pediatric patients dealing with brain tumors or abnormal tissues triggering seizures. In some children, the affected region reside deep within the brain, these children might lack alternative treatment avenues.

Physicians suggest laser ablation as a treatment for brain tumors or epilepsy only if they learn the following:

• Alternative treatments, such as anti-seizure medications, have been attempted but proved ineffective.

• The location of the lesion.

• The size of the lesion. Laser ablation surgery is most effective for small lesions because the probe’s tip heats a small area.

• The region where seizures originate if the child is epileptic. If physicians are unable to pinpoint this region, alternative treatments may be beneficial.

• The other options pose greater risks, such as when dealing with deep lesions that are difficult to access via traditional open brain surgery.

Laser ablation may be advantageous for the child if they have a deep brain tumor or suffer from epilepsy due to:

• Tuberous sclerosis.

• Hypothalamic hamartoma.

• Focal cortical dysplasia.

• Hippocampal sclerosis.

How Is the Procedure of Laser Ablation Brain Surgery Performed?

At first, a thin catheter, less than two millimeters in diameter, is directly inserted into the brain through a minute hole into the skull by a procedure called craniotomy (a small hole is made in the skull to remove the damaged part of the brain). The heat generated from the lasers tends to damage the DNA (the genetic material of the human) in the cells that cause brain cells, leading to death.

Recurring headaches and other side effects, such as bone resorption risk, can be skipped with the laser ablation technique. If the lesion is deeply present in the brain, extensive damage to the normal brain parts can be avoided during the surgical procedure.

This procedure also helps in having a shorter hospital stay.

Laser ablation surgery is not implemented for several reasons. The energy source could sometimes be more reliable. When the laser probe is excessively hot, the surrounding normal tissue of the brain can be damaged. When, at times, the probe is not too hot, the area is destroyed by the surgeon again and again. When the volume or size of the lesion is very big, the surgeon can make many channels to destroy the area.

The surgeon places the laser probes in the brain very accurately with the help of stereotaxis. This computer-based, three-dimensional coordinate system recognizes small target areas in the brain. A specific specialized frame is placed in the child, and the tumor's location is easily identified using the computer coordinate system. Upon the exact location, the laser probe is inserted manually through the holes.

Surgeons also use robot-guided stereotaxis to place the probe at the location of the lesion carefully.

Laser ablation surgery also uses a magnetic resonance imaging technique, which helps guide the surgery. MRI is used for monitoring the surgery. The surgeon visualizes the images that can help the surgeon map the way for the procedure. To avoid damage to the surrounding normal brain cells and give the surgeon an idea of the ablated region. Neuroblate is another laser ablation technique.

What Are the Uses of Laser Ablation Brain Surgery?

• Laser ablation brain surgery is used in the presence of a lesion in the brain.

  1. The gray matter lesions.

  2. Focal lesions.

  3. Well-defined lesions.

• Hypothalamic hamartomas can cause epilepsy and are treated with laser ablation. It is also used to treat epilepsy due to cortical dysplasias, hippocampal sclerosis, cortical malformations, and tuberous sclerosis.

• Disconnection of white matter fibers can be done by most surgeons using laser ablation. Examples include corpus callosotomy or removal of the residual connections after failed brain surgery.

• In children having various focal areas of epilepsy, such as tubers. This laser ablation technique avoids several craniotomies to gain access to the tubers.

• As the laser ablation technique is a new surgical technique, only a few cases were reported, and statistics show higher chances of seizure control with this procedure and the cognitive outcome.

How Can the Patient Get Ready for a Laser Ablation Procedure?

• The laser ablation technique can last for about four to five hours, and complete hair on the head has to be removed.

• Placement of the stereotactic frame and MRI scan is taken. With reference to the frame and the scan, a picture of the location of the lesion is obtained from the outside of the skull.

• A surgical incision is made on the scalp, and a small hole the diameter of a pencil is made in the skull. The lesion is located, and the ablation is carried out. Once the lesion is destroyed, an MRI scan is again taken to review the procedure.

• The patient is discharged a day after the surgery is performed.

• Post-operative care has to be taken along with using prescribed medications.

• Physical therapy or rehabilitation is not required, and the patients can return to their daily activities.

What Are the Risks Associated With Laser Ablation Brain Surgery?

• So far, no risks have been reported for any complications. There are no fatal complications in children also.

• Most of the patients reported temporary weakness and difficulty with memory and language.

Conclusion

Laser ablation brain surgery is an advanced procedure that specialized surgeons perform. Effective results can be obtained by following a proper protocol throughout the procedure. Treatment of brain tumors is done with the help of this technique. As a surgical process, it is also associated with risks that are disclosed to the patient, and necessary preventive measures should be taken to combat them.