Laser procedure for pediatric patients with epilepsy holds advantages over traditional brain surgery
Using a laser for a rare brain surgery to treat falls that suddenly cause a child with epilepsy to fall has some advantages over a traditional open craniotomy, including shorter hospital stays for patients, according to a study led by UT Southwestern. researchers. 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 for the child to recover from, and therefore easier for parents and families,” said Angela V. Price, MD, assistant professor of neurological surgery and pediatrics at UTSW, who provides the surgical epilepsy. service at Children’s Health.
In recent years, Price and a few other pediatric neurosurgeons across the country have begun to perform a minimally invasive procedure, in which a tiny laser is inserted through a small incision in the skull to remove part of the corpus callosum, a fabric tape, burn away. that connects the left and right hemispheres of the brain. Traditional surgery involves a large incision to remove part of the skull for access. Price and colleagues assessed 19 patients who underwent 24 procedures: 16 had undergone open corpus callosotomies and eight underwent laser procedures.
The results showed that drop attacks were practically eliminated for both types of procedures and the rate of postoperative complications was low. But the laser technique required a patient to spend less than half the time in the pediatric ICU and shorten the total length of hospital stay (4.6 days versus 5.7 days). In addition, children did not require inpatient rehabilitation, compared with about 20 percent of those who received an open repair, and lost 12 times less blood (7 milliliters versus 84 milliliters).
Price notes that surgery time for laser procedures was nearly double that of the open procedure group (492 minutes versus 249 minutes), due in part to MRI imaging before and during surgery. The laser patients also took corticosteroids about three times longer than those with open procedures.
Children’s Medical Center is the only hospital offering these procedures in Dallas, and one of the relatively few in the U.S. As surgeons better understand the benefits of these procedures, I predict they will become a more popular option for patients whose attacks have the can best be controlled by these minimally invasive procedures. “
Angela V. Price, Member, Peter O’Donnell Jr. Brain Institute
UT Southwestern Medical Center
Caruso, JP, 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.