Laser procedure for pediatric patients with epilepsy holds advantages over traditional brain surgery

Using a laser for a rare brain surgery to treat drop seizures, which cause a child with epilepsy to suddenly fall, holds some advantages over a traditional open craniotomy, including shorter hospital stays for patients, a study led by UT Southwestern researchers indicates. The findings, published in the Journal of Neurosurgery, provide the first quantitative data comparing the two types of surgery, called corpus callosotomies.

“Our data shows that laser corpus callosotomies are easier on the child to recover from, and consequently, easier on parents and families,” says Angela V. Price, M.D., assistant professor of neurological surgery and pediatrics at UTSW, who leads the surgical epilepsy service at Children’s Health.

In recent years, Price and a few other pediatric neurosurgeons across the country have started performing a minimally invasive procedure, in which a tiny laser is inserted through a small incision in the skull to burn away a portion of the corpus callosum, a band of tissue that connects the left and right hemispheres of the brain. The traditional operation involves a large incision to remove a portion of the skull for access. Price and colleagues reviewed 19 patients who underwent 24 procedures: 16 had gone through open corpus callosotomies, and eight underwent laser procedures.

Results showed that for both types of procedures, drop seizures were practically eliminated, and rates of post-surgical complications were low. But the laser technique required a patient to spend less than half the time in the pediatric ICU and decreased the overall length of stay in the hospital (4.6 days versus 5.7 days). In addition, children required no inpatient rehabilitation compared with about 20 percent of those receiving open repair, and lost 12 times less blood (7 milliliters versus 84 milliliters).

Price notes that the operating time for laser procedures was nearly double that of the open procedure group (492 minutes versus 249 minutes), partially due to MRI imaging before and during the operation. The laser patients also took corticosteroid drugs about three times longer than those who had open procedures.

Children’s Medical Center is the only hospital providing these procedures in Dallas, and one of relatively few in the U.S. As surgeons better understand the advantages of these procedures, I predict they’ll become a more popular option for patients whose seizures are best controlled by these minimally invasive procedures.”

Angela V. Price, Member, Peter O’Donnell Jr. Brain Institute

Journal reference:

Caruso, J.P., et al. (2021) Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy. Journal of Neurosurgery. doi.org/10.3171/2020.7.PEDS20167.

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