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Chicago Tribune
By Anne Stein, Special to Tribune Newspapers
Published: February 15, 2012
Surgery for the disorder has become much safer and effective. “The risk of dying from seizures is more than the risk of operation for the population of patients eligible for surgery,” says Stern.
Surgery has been done on infants and the elderly, and if someone’s a surgical candidate, says Sirven, “all best evidence points to surgery being the most cost-effective, safe and best therapeutic option for patients with drug-resistant epilepsy.”
Last summer, surgeons at Texas Children’s Hospital in Houston used MRI-guided laser surgery on several patients with epilepsy for the first time, allowing for a much less invasive path through the skull and brain.
“That speaks to the variety of surgical techniques available,” explained Stern. “It’s an improvement on an older technique, and it’s encouraging to see continual improvement in surgical approaches.”
“This is an era when neuroscience is exploding with information, and all of this has an effect on epilepsy and our understanding of it,” Stern said. “There’s a lot that’s changing the treatment of epilepsy and moving it forward. For patients, even in very challenging situations, hope is reasonable because the field is evolving.”
Source: http://articles.chicagotribune.com/2012-02-15/health/sc-health-0215-epilepsy-20120215_1_epilepsy-surgery-epilepsy-foundation-seizures
More information about Texas Children’s Hospital MRI-guided laser surgery
NYTIMES
By Nicholas Bakalar
Published: March 12, 2012
Surgery for epilepsy is usually seen as a last resort for patients when medications do not work, and it is often delayed for many years after the failure of drug treatment. Now a randomized, controlled trial suggests that surgery as soon as possible after the failure of two antiepileptic drugs is a significantly better approach than continued medical care.
Read more…
MRI Guided Laser Ablation for Intracranial Neoplasms
Thursday, November 17, 2011
7:00-8:00 AM
Biomedical Research Building
Room 252
Shabbar F. Danish, MD
Assistant Professor, Department of Surgery
Division of Neurosurgery
UMDNJ - Robert Wood Johnson Medical Center
Target Audience
This program has been designed for faculty, residents, medical students, nurse practitioners and nurses in the departments of neurology, neurosurgery, surgery and orthopaedic surgery.
Educational Objectives
After completing this activity, participants should be able to:
· Describe the basics of allied specialties such as anesthesia, trauma and neurology and developing an infrastructure for interdisciplinary team care
· Discuss the recent advances in various aspects of clinical and basic neurosciences as applied to neurosurgery, such as tumor/oncology, spine/pain, pediatrics/genetics, and functional/neurophysiology
· Exposure to emerging trends and new technologies in neurosurgery with an emphasis in spine and endovascular therapeutics and a focus on the role to minimally invasive techniques
· Review the ethical evidence-based, and economic aspects of neurosurgical practice in the 21st century
Accreditation
The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation of Credit
The Perelman School of Medicine at the University of Pennsylvania designates this live activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
DATE:
11/17/2011 - 7:00am - 8:00am
LOCATION
United States
CNS 2011 (Washington D.C. October 3, 2011) presented a good opportunity to catch up with recent developments with laser thermal ablation technology in neurosurgery. The reception included 3 presentations:
Initial Single Center Experience with MRI-guided Laser Thermal Ablation of Brain Tumors; Shabbar Danish, M.D., Director, Brain Tumor Center, Robert Wood Johnson Hospital.
Pediatric Epileptic Foci Ablation; Daniel J. Curry, M.D., Director of Pediatric Surgical Epilepsy and Functional Neurosurgery, Texas Children’s Hospital.
Epileptic Foci Ablation and Future Directions; Robert Gross, M.D., Director, Stereotactic and Functional Neurosurgery and Epilepsy Surgery, Emory University Hospital.
Select slides summary below:
  
  
  
  
  
  
 
 Dr. Amit Verma, of Methodist Hospital, performed the minimally invasive surgery last month on a 48-year-old Houston-area woman who has been seizure-free since. The procedure was the first of a 10-patient clinical trial planned at Methodist.
In addition, Dr. Nitin Tandon, a neurosurgeon at the University of Texas Medical School at Houston, said last week he hopes to use the technique on an adult with epilepsy in about four weeks. He said he’d like to do 10 to 15 laser surgeries a year as part of a trial.
The activity follows a Texas Children’s announcement in July that they have successfully treated six children with lesions in hard-to-access regions of the brain with laser surgery, a technique used in brain cancer but never in epilepsy. In the procedure, doctors insert a laser probe through a hole in the skull with the diameter of a pen and burn the lesions.
3 million with disorder
Conventional surgery for epilepsy, in which doctors remove a bone flap from the skull and cut through delicate areas of the brain, commonly causes serious complications.
Epilepsy is characterized by seizures, strong surges of electrical activity that affect part or all of the brain, often resulting in convulsions or loss of consciousness.
About 3 million people in the United States have some form of the disorder, and medication doesn’t stop the seizures in about a third of the cases. An MRI must show clearly defined lesions for someone to be a candidate for laser surgery.
Following Texas Children’s work, a doctor at Emory University Medical Center in Atlanta did the first two laser surgeries for epilepsy in adults.
todd.ackerman@chron.com
Read more: http://www.chron.com/disp/story.mpl/metropolitan/7697614.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+houstonchronicle%2Fmetro+%28chron.com+-+Houston+%26+Texas%29#ixzz1VI5xOpJS
New procedure significantly reduces risk of patient complications and recovery time.
(HealthNewsDigest.com) – HOUSTON, July 18, 2011 — Texas Children’s Hospital is the first hospital in the world to use real-time MRI-guided thermal imaging and laser technology to destroy lesions in the brain that cause epilepsy and uncontrollable seizures.
According to hospital experts, this new surgical approach offers a safer and significantly less invasive alternative to craniotomy, currently the most commonly used cranial surgical treatment for epilepsy. For high-risk patients with deep brain lesions, this new technique can be particularly life-changing because the MRI-guided laser probe utilizes a much smaller pathway through the brain to reach a deep lesion. This reduces the risk of patient complications related to contact with surrounding brain tissue. In addition, the MRI-guided laser probe is inserted through a hole in the skull that is only 3.2 mm (about the diameter of a pen) versus the removal of a larger area of skull bone for a craniotomy. Because it is a less invasive procedure, patient recovery time is much shorter.
More than three million people in the U.S. are affected by epilepsy, including about 300,000 children under the age of 14. Uncontrollable seizures can affect a child’s memory, concentration, motor skills, school performance and quality of life. Drug therapies control seizures in about 60 percent of those with epilepsy. Invasive craniotomy, nerve stimulation and special diets are treatment options for patients who do not respond to medication.
“Based on our experience, we believe the use of MRI-guided laser surgery will change the face of epilepsy treatment and provide a life-changing option for many epilepsy surgery candidates — both children and adults,” said Dr. Angus Wilfong, director of Texas Children’s comprehensive epilepsy program and associate professor of pediatrics and neurology at Baylor College of Medicine.
The first surgeries were performed by Dr. Daniel Curry, Texas Children’s director of pediatric surgical epilepsy and functional neurosurgery and assistant professor of neurological surgery at Baylor College of Medicine, with Wilfong.
Five surgeries using this MRI-guided laser procedure have been successfully performed at Texas Children’s Hospital on pediatric epilepsy patients ranging in age from five to 15 years old, with widely varied types of brain lesions. In all cases, patients have been seizure-free since surgery and most were released within one to five days.
“While we have been successful in curing epilepsy through open cranial surgery for quite some time, the benefits of this new approach in reducing risk and invasiveness while providing instant therapeutic effect may open the door for more epilepsy patients to see surgery as a viable option,” said Curry.
The surgery is performed by first mapping the area of the brain where the lesion is located using magnetic resonance imaging. The catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures.
Wilfong noted that MRI-guided laser surgery has been successfully used in treating brain tumors and that he and Curry saw that its same attributes would apply to deep seated epilepsy-causing lesions. The neurologist and neurosurgeon introduced a first-of-its-kind trial of the treatment to pediatric epilepsy patients at the Blue Bird Circle Clinic for Pediatric Neurology at Texas Children’s Hospital.
Changing the life of a young patient
A recent example of the effectiveness of this new surgery is nine-year-old Texas Children’s Hospital patient Keagan Dysart, of Converse, Texas, who suffered from two types of epileptic seizures when he was diagnosed with a hypothalamic hamartoma in his brain. The gelastic seizure caused him to giggle and laugh uncontrollably two or three times an hour. Keagan would also periodically experience a tonic seizure, with generalized body stiffening and loss of awareness that caused him to fall asleep for sometimes up to an hour afterward. Keagan’s case was particularly high risk because his lesion was located in the hypothalamus, near the brain stem. In this highly sensitive region, there are a myriad of potentially serious complications from surgery including loss of sight, damage to the pituitary gland, stroke from artery damage or development of diabetes insipidus (DI), a potentially fatal condition where the kidneys are unable to conserve water because of disruption to the area of the brain that releases the body’s anti-diuretic hormone.
The location, size and complexity of Keagan’s brain lesion made him an ideal candidate for the new surgical procedure, which was successfully performed in March without any surgical complications. He is now seizure-free.
“Knowing the complexity of Keagan’s case, the decision to go forward with this surgery was the toughest decision and the best decision we ever made,” said Khris Dysart, Keagan’s father.
Ranked among the nation’s top four hospitals for pediatric neurology and neurosurgery by U.S. News & World Report, Texas Children’s Hospital provides specialty care for a wide range of neurological disorders delivered by leading experts. Equally committed to leadership in research, the hospital also operates the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, the first institute in the world devoted to basic research of childhood neurological diseases including extensive research on epilepsy.
More information on Texas Children’s Hospital Neurology and Developmental Neuroscience practice is found at www.texaschildrens.org/CareCenters/Neuro/Neurosurgery/laser_cell_ablation.aspx
About Texas Children’s Hospital
Texas Children’s Hospital, a not-for-profit organization, is committed to creating a community of healthy children through excellence in patient care, education and research. Consistently ranked among the top children’s hospitals in the nation, Texas Children’s has recognized Centers of Excellence in multiple pediatric subspecialties including the Cancer and Heart Centers, and operates the largest primary pediatric care network in the country. Texas Children’s is completing a $1.5 billion expansion, which includes the Jan and Dan Duncan Neurological Research Institute; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; and Texas Children’s Hospital West Campus, a community hospital in suburban West Houston. For more information on Texas Children’s, go to www.texaschildrens.org. Get the latest news from Texas Children’s by visiting the online newsroom and on Twitter at twitter.com/texaschildrens.
For information on research at Baylor College of Medicine, please go to www.bcm.edu/fromthelab.
src http://epilepsyu.com/blog/laser-surgery-for-revolutionary-new-epilpesy-treatment/
Friday, July 16, 2010
New Brunswick, NJ – A leading neurosurgeon has performed the nation’s first laser-assisted brain surgery for a specific type of resistant brain tumor using technology so advanced that the patient went home the next day.
Shabbar F. Danish, MD, Director, Stereotactic and Functional Neurosurgery and Assistant Professor at UMDNJ-Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital |
Shabbar F. Danish, MD, Director, Stereotactic and Functional Neurosurgery and Assistant Professor at UMDNJ-Robert Wood Johnson Medical School (RWJMS) and Robert Wood Johnson University Hospital (RWJUH), used the laser thermal ablation technique to operate on a patient with a recurring brain tumor after two previous surgeries and radiation did not permanently destroy the growth.
The technology is the latest addition to RWJUH and RWJMS’s growing expertise in the division of neuroscience. Dr. Danish specializes in the latest in stereotactic neurosurgery, which involves targeting small areas in the brain with techniques used to treat everything from Parkinson’s disease to brain tumors.
Susanna Denude of Riverdale, N.J., was diagnosed with an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain. While only six hospitals in the country offer laser-assisted thermal ablation, this is the first time in the nation that the treatment was used for an intracranial ependymoma, explains Dr. Danish.
“This is a tool for patients with tumors who have been told they do not have other options,” Dr. Danish says about laser-assisted thermal ablation. “This is also a viable option for patients who do not want radiation therapy or general anesthesia. Additionally, we can take their hospital stay from four to seven days down to 24 hours.”
The technique involves placing a laser directly into the tumor and then guiding the laser to perform thermal ablation, or killing it with heat, while leaving the surrounding areas of the brain untouched. The entry hole that is made through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure.
“In order to find the exact spot where the tumor is located, we use a GPS system for the brain so that we can identify the exact target location during laser placement, load and then map out a path in the operating room,” says Dr. Danish.
After the laser is placed in the brain, the patient is moved to an MRI unit, where the operating team can observe in real time how the brain changes temperature with respect to the laser. “It uses a light energy in order to deliver the thermal therapy,” adds Dr. Danish. Only local anesthesia is used and the patient is able to go home the day after surgery.
“What we hope for Ms. Denude is that she goes on now to live a full life,” Dr. Danish says. “She’s a very active woman.”
Click here to request more information about laser ablation for the treatment of brain tumors.
About Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital (RWJUH) is a 600-bed academic medical center and the principal hospital of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ. Robert Wood Johnson is an innovative leader in advancing state-of-the-art care. RWJUH is the first hospital in the nation to implant the AbioCor self-contained artificial heart since the device received FDA approval in 2006. RWJUH is one of only three sites in the nation approved to offer this groundbreaking technology.
Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women’s and children’s care including The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital (www.bmsch.org). The hospital is also a Level 1 Trauma Center and serves as a national resource in its ground-breaking approaches to emergency preparedness.
The hospital has earned significant national recognition for clinical quality and patient safety. Robert Wood Johnson University Hospital is among U.S.News & World Report’s 2011 “America’s Best Hospitals.” It is the fifth consecutive year that RWJUH has achieved this prestigious ranking. The American College of Surgeons’ Commission on Cancer has rated RWJUH among the nation’s best comprehensive cancer centers. The Leapfrog Group rated RWJUH as one of the 50 exceptional U.S. hospitals, as published inConsumers Digest magazine. Harvard University researchers, in a study commissioned by The Commonwealth Fund, identified RWJUH as one of the top 10 hospitals in the nation for clinical quality. RWJUH is also a recipient of the prestigious Magnet Award for Nursing Excellence for more than 10 consecutive years.
Doctors cut a hole in Lester Beck’s skull two days ago and removed a brain tumor. He goes home today.
Nope, he didn’t spend a day in intensive care, followed by days in a hospital room, followed by six months of recovery to get his strength back. Beck has a pair of staples in his head instead of a Frankenstein-like scar. He was awake for the surgery and had only one question for the surgeon when he was wheeled out: “Did you cook it all?’
 Photo by Brad Nettles. The Post and Courier. Lester Beck was the first patient to undergo laser brain surgery at MUSC and is just the 30th person in the world to have it done. Ray Turner, 33, a Medical University of South Carolina neurosurgeon, performed the first laser brain surgery in the hospital’s history, only the 10th performed in the United States and the 30th in the world. He used string-sized, fiber optic technology he couldn’t have anticipated during his medical training, and his residency ended last year.
“It’s exhilarating,” he said Thursday.
“This is what we want to do in medicine, stay on the cutting edge.”
The device is threaded like a wire through a one-eighth-inch incision in the skull, implanted in the tumor like a biopsy needle and turned on for spurts of a few seconds.
“We watched the tumor basically bleed, cook, burn. Watched it die,” Turner said.
Beck, 68, a former math teacher and bartender who lives on Pawleys Island, was mostly nonplussed at the whole thing.
“You don’t really feel anything. You just hear the MRI (magnetic resonance imaging device) make a clackety-clack noise like a jack hammer,” he said.
Beck chose the option over traditional surgery, which involves removing a piece of skull and then cutting out the tumor. “Somebody cutting open your mind,” Beck said, giving a little, disbelieving laugh, “that’s quite something.”
All in all, his knee replacement last year was a lot more traumatic.
Beck’s tumor lent itself to the procedure because of its relatively small, golf-ball size and because it was easy to get to, Turner said. Asked if the laser worked better than traditional surgery, Turner said, “We’ll see. This is just so new that we’re still learning about it. Where it’s going to fall in the overall scheme of curing a patient, we’re still sorting out that information.”
As for Beck, two weeks ago he was having a seizure on the floor in his house. Now he’s headed for Litchfield beach.
“I love to go to the beach,” he said. “I’d like to bike ride down to Huntington Beach State Park.”
src http://www.postandcourier.com/news/2009/may/22/rare_laser_brain_surgery_first_at_musc83202/
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