Laser Ablation Surgery for Epilepsy and Brain Tumors

What is laser ablation surgery?

Laser ablation (LAY-zer ab-LAY-shun) surgery is a treatment to remove tumors and other lesions. It uses an MRI-guided laser probe to deliver light and heat to destroy unwanted cells.

Neurosurgeons use an advanced surgical tool called ROSA Brain to place a thin laser probe in your child’s brain and do the surgery. Your child will be in a MRI (magnetic resonance imaging) scanner during the procedure so surgeons can use real-time images and place the probe in the exact spot, down to the millimeter. Surgeons view a computer screen that shows exactly what area is being heated and how much.

Laser ablation surgery is safer and more precise than traditional surgery, with fewer side effects. In traditional surgery, the surgeon opens the skull and removes tissue. That may not be possible if they need to operate deep in the brain.

What’s special about laser ablation surgery at Seattle Children’s?

Seattle Children’s is among the few children’s hospitals in the country that offer laser ablation for epilepsy and brain tumors. Neurosurgeons and doctors from our Epilepsy Program work together to provide this minimally invasive procedure. For children with brain tumors or lesions that cause seizures, this treatment may be a cure. 

The experts and experience you need

One of the most experienced teams in the country will perform your child’s laser ablation surgery. Dr. Jeffrey Ojemann is a board-certified pediatric neurosurgeon who is considered a national expert in laser ablation for epilepsy and brain tumors. 

Seattle Children’s was among the first in the nation to offer this treatment. More cases mean greater surgical expertise and a sharper ability to determine if surgery is even needed — and that adds up to better outcomes.

The treatment that’s best for your child

Treatment decisions for epilepsy and brain lesions are complex. We look at your whole child. First, they will have tests and imaging studies to find out more about their seizures or tumor. Our neurosurgeons use an advanced surgical tool called ROSA Brain to help pinpoint the problem areas.

We also talk with you and your child to understand how your child is affected and how other treatments have worked. Taking into account everything we learn, our team will explain:

• If laser ablation is an option
• If it’s a better option than traditional surgery
• If we recommend it for your child and why

Among the nation’s top neurosciences programs

• Seattle Children’s has the only Epilepsy Program exclusively dedicated to pediatrics in our region that is accredited level 4 by the National Association of Epilepsy Centers (NAEC). As a level 4 center, we use the most advanced technology to diagnose epilepsy and assess patients before surgery. Only level 4 centers like ours perform a broad range of complex surgeries to treat epilepsy. Our WAMI region includes Washington, Alaska, Montana and Idaho.
• We are the largest brain tumor center for children in the Northwest and among the nation’s busiest centers.

Advancing care with research

Seattle Children’s doctors lead research in the lab and with patients to improve treatment and quality of life for children with epilepsy and brain tumors. Our patients have the option to take part in research studies of promising new treatments. These are called clinical trials. They can be especially relevant if your child’s disorder is not well controlled with standard medicines or surgeries.

Experts from Seattle Children’s often present research findings at national conferences, including the American Epilepsy Society’s annual meeting. We are leaders in research groups such as Children’s Oncology Group (COG)Pacific Pediatric Neuro-Oncology Consortium (PNOC).

• Learn more about Seattle Children’s research and clinical trials.

Who can benefit from laser ablation surgery?

Laser ablation may be a good choice, and even a cure, for children with brain tumors or abnormal tissue that causes seizures. If the damaged area is deep in the brain, these children may have no other treatment options.

Doctors recommend laser ablation for epilepsy or brain tumors only after they learn:

• If other treatments, like antiseizure medicines, have been tried and failed.
• Where the lesion is.
• Its size. Laser ablation surgery works best on small lesions because the tip of the probe heats a small area.
• The area where seizures start if your child has epilepsy. If doctors can’t identify this area, other treatments may help.
• Whether other options are riskier. For example, some lesions are deep and hard to reach with traditional open brain surgery.

Your child may benefit from laser ablation if they have a tumor deep in the brain or have epilepsy from:

• Hypothalamic hamartoma
• Hippocampal sclerosis that causes temporal lobe epilepsy
• Focal cortical dysplasia, in some cases
• Tuberous sclerosis

To find out if laser ablation may be an option for your child, contact the Neurosciences Center at 206-987-2016.

What happens during laser ablation surgery?

• We use an advanced surgical tool called ROSA Brain to help the surgeon insert a probe in the best place to reach the lesion in your child’s brain. The probe is a very thin, flexible tube that sends out light.
• The surgeon makes a small cut (just a little wider than the probe) in your child’s scalp and skull, then inserts the probe.
• We move your child into the MRI scanner. Using the MRI display, the surgeon checks the precise placement of the tip of the probe in your child’s brain.
• The computer display shows where tissue is being heated and how warm it is getting. This helps the surgeon decide how much treatment to give and when to stop.
• The treatment with the laser takes only a few minutes. The careful setup before treatment takes longer. The total time under anesthesia is about 4 hours.

MRI-Guided Laser Ablation Surgery (Video 1:59)

What are the benefits and risks of laser ablation?

Benefits

Likely benefits of laser ablation for deep tumors and lesions include:

• Less harm to healthy tissue on the way in
• More precise treatment at the lesion, reducing the risk of harm to your child’s vision, movement, memory, language, learning and other brain functions
• Easier on your child's body, leading to faster recovery and less pain

Risks

Like all surgery, laser ablation has some risks, such as the chance of infection or harm to a healthy part of the brain. Your child’s surgeon will talk with you about the risks for your child.

Children who have laser ablation can still have open surgery later if laser ablation doesn’t cure their disorder.

Results

The results can vary. For children with brain tumors or other lesions, this treatment may be a cure.

About half of patients with epilepsy become seizure free, sometimes within a week. This is about the same success rate as with open surgery, but with less risk. Some patients still have seizures, but they are less severe or happen less often. It may take up to a year to be sure the procedure worked. In some patients, seizures stop for a while but then come back.

Contact Us

For more information, contact the Neurosciences Center at 206-987-2016.

Schedule an appointment 

• To make an appointment, you can call us directly or get a referral from your child’s primary care provider.
• We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children's.
• How to schedule an appointment at Seattle Children’s.
• If you already have an appointment, learn more about how to prepare.
• Learn about resources such as useful websites, videos and recommended reading for you and your family.
• Providers, see how to refer a patient.