Mayfield neurosurgeon performs region's first laser brain surgeries for epilepsy

A Mayfield Brain & Spine neurosurgeon has performed the region's first minimally invasive laser ablation surgeries for adult patients with epilepsy.

The surgical team used a laser to heat and destroy a targeted area of brain tissue that was causing seizures. The laser was inserted through a tiny hole in the skull.

George Mandybur, MD, a specialist in epilepsy surgery and movement disorders, performed the procedures at the University of Cincinnati Medical Center in collaboration with the Epilepsy Center at the UC Gardner Neuroscience Institute. The surgical team used the new Visualase® technology, which is marketed by Medtronic. Dr. Mandybur is currently awaiting permanent access to the technology.

The MRI-compatible procedure offers significant benefits to a patient who requires surgery for temporal lobe seizures that cannot be controlled with medication. Dr. Mandybur and the surgical team use a laser to heat and destroy a precisely targeted area of brain tissue that is causing seizures. Rather than opening the skull in a craniotomy and removing a portion of the brain – a procedure called a temporal lobectomy -- the surgeon creates a small hole with a twist drill, inserts the laser, and then burns the targeted area. Surrounding healthy tissue is spared.

"This treatment will significantly cut down on the number of cases that involve a craniotomy and removal of a portion of the temporal lobe," Dr. Mandybur says. "Even though this treatment will be somewhat less effective than open surgery in reducing seizures, the risk of complications will be greatly reduced. It's an important tradeoff."

Importantly, laser ablation does not prevent surgeons from performing a temporal lobectomy at a later date.

The treatment begins with extensive testing in an epilepsy monitoring unit. During testing, neurologists and technicians identify the seizure locus, the area where the patient's seizures start. Functional MRI scans are used to determine whether the seizure locus can be safely targeted without harming the patient's ability to think or communicate.

During surgery, the surgeon places a thin laser fiber through a 3-millimeter hole into the seizure focus. The patient is then taken to an MRI suite, where heat emanating from the laser can be quantified and the target can be ablated. "We allow the heat to rise to a specified temperature while targeting the affected area," Dr. Mandybur says. The entire procedure takes a few hours to perform.

"This is an exciting new technology that has potential for not only uncontrolled seizures, but also for brain tumors that may be difficult to remove through conventional surgical techniques."

Mayfield Brain & Spine is the full-service patient care provider of the Mayfield Clinic, one of the nation's leading physician organizations for neurosurgical treatment, education, and research. With more than 20 specialists in neurosurgery, interventional neuroradiology, physical medicine and rehabilitation, and pain management, Mayfield Brain & Spine treats 25,000 patients from 35 states and 13 countries in a typical year. Mayfield physicians specialize in the treatment of back and neck pain, sciatica, Parkinson's disease, essential tremor, NPH, epilepsy, brain and spinal tumors, stroke, moyamoya, brain aneurysms, Chiari malformation, scoliosis, kyphosis, facial pain, facial twitch, trauma, concussion, spinal cord injury, and carpal tunnel. As leading innovators in their field, Mayfield physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for spinal diseases and disorders, brain tumors, and neurovascular diseases and disorders.