Doctors at Tel Aviv Sourasky Medical Center.
(photo credit: LIOR TSUR / SOURASKY)
For the first time outside the US, doctors at Tel Aviv Sourasky Medical Center have used an innovative technology that includes advanced laser and MRI technologies for ablation of the part of the brain that causes epileptic attacks in patients for whom medications are not helpful.
The procedure is now offered in the neurosurgery department by Prof. Yitzhak Fried and Dr. Ido Strauss in collaboration with Dr. Firas Fahoum, the director of epilepsy service.
Fried, the head of Sourasky’s functional neurosurgery unit, specialized in the American method and brought the knowledge and the technology to Israel.
Now, patients with serious epileptic seizures can benefit from the treatment without extensive invasive procedures requiring the opening of the skull.
“If in the past we had to consider surgery in cases where the patient did not respond to medication, we can now make do with a minimally invasive procedure that is almost as successful as open surgery,” explained Strauss.
“Moreover, these are sudden seizures that may end in trauma, impair their quality of life and, in some cases, end in death.”
The quick, minimally invasive procedure also requires a relatively short hospital stay compared to the open surgery.
The new technique involves Laser Interstitial Thermal Therapy (LITT) technology, using a device called Visualase.
The technique allows for real-time monitoring of the brain-ablated area.
The procedure is performed in two stages, and requires close collaboration among the surgical team, which includes Dr. Daniel Hyatt, who specializes in neurosurgery anesthesia; Dr. Orna Eisenstein, a neuroradiologist who manages the epilepsy service’s imaging unit; Prof. Dafna Ben-Bashat, who is responsible for MRI equipment; and medical engineering and informational systems experts.
In the first stage of the operating room, a small optic fiber is inserted carefully using a stereotactic navigation system through a small hole in the skull about 4 mm. in diameter. Then the optical fiber is connected to the Visualase system, while an MRI scanner monitors real-time brain temperature maps and closely monitors the size of the ablated tissue. This preserves adjacent brain regions that can be responsible for critical functions.
“Today, we know that the source of the disorder that causes epileptic seizures is found in neural networks in the brain and that the attacks can be prevented by proper medical treatment,” explained Fahoum. “In most cases, patients are given medication to try to control the seizures. But if this doesn’t help, it is necessary to consider neurosurgical intervention, in cases where the area where the seizures begin is located and surgically removed. But seizures come as a surprise and may cause cumulative damage to the cognitive and mental functioning of the patients along with physical injuries when they fall to the ground.
“It is important to understand that epilepsy affects all functional abilities,” Fahoum stressed. “It affects the patient’s routine, his ability to function at work, the possibility of driving and countless social difficulties for the patients and their families.”
There are now a number of surgical options, from implantation of nerve pacemakers and neuromodulation to the removal of the focal point from which the seizures begin. A comprehensive diagnosis is required in the epilepsy unit, which tries to locate the area from which the seizures begin. There may be more than a single focal point, and sometimes the location may be close to areas responsible for critical neurological functions.
Parents of children with recurrent epileptic attacks despite taking medication will be happy to hear that the procedure can also be performed on youngsters.
“We have to take into account that in youngsters, the skull is still soft. We may have to wait until the skull is thick enough for us to attach the optic fiber, but in some cases it can certainly be a good minimally invasive therapeutic option with easier recovery than open-skull surgery. It is worth considering the option at an early age in appropriate cases,” Strauss said.
“I remember very well the first case I performed at the University of California at Los Angeles Medical Center,” recalled Fried. “A young woman who suffered epileptic seizures at a frequency of about 30 per day due to a tiny focus in the depths of the brain close to memory and vision centers could until then be treated only surgically. I inserted the laser device into the brain, and the change was immediate and amazing. Immediately after the operation and three years since, she has had no seizures.”