Treatment Methods for Epilepsy Surgery

Surgical Options

• Visualase® MRI-Guided Laser Technology

  A highlight of our minimally invasive epilepsy surgery program is the recent introduction of the Visualase® MRI-Guided Laser Technology. This technique uses a 1.6 mm laser probe which is accurately placed in a seizure focus. The seizure focus is then destroyed using laser thermal energy while monitoring this event using real time intraoperative MRI.

  The advantage of this technique is that we can achieve precise destruction of the part of the brain causing seizures without injury to other critical parts of the brain near it. The software in this system protects brain structures nearby from laser energy.

  The small size of the incision significantly reduces postoperative hospitalization. Most of the children who undergo this procedure go home the next morning after surgery.

• Minimally Invasive Robotic Stereotactic EEG (SEEG)

  Using the ROSA neurosurgical robot, we can define the area in the brain where seizures arise by placing tiny wires measuring only about 1mm in diameter through small (2.5 mm) drill holes in the skull in a minimally invasive manner. This procedure, which is called stereo-EEG or SEEG, is a major advance compared to the traditional procedure, called subdural grid implantation, which involved making a large scalp incision and removing a piece of the skull to gain access to the brain and place wires contained in large plastic sheets on the brain.

  Children undergoing the SEEG procedure experience much less post-operative pain compared to those who undergo grid placements, and the rate of infection is also less. Studies have shown that the SEEG procedure is just as efficacious in identifying the source of seizures, and that the rates of seizure freedom after epilepsy surgery following the SEEG procedure are just as good as that following traditional grid procedures.

• Intraoperative MRI Scanner

  We have a dedicated 1.5T Philips Intraoperative MRI scanner which enables real-time MRI guided procedures during epilepsy surgery. We have shown in our research that we are able to achieve higher rates of seizure freedom following epilepsy surgery using our intraoperative MRI to guide resection of the area of the brain that was responsible for the seizures.

Brain Stimulation

• Neuropace® Responsive Neurostimulator (RNS) Brain Implants for Epilepsy

  The objective here is direct stimulation of the seizure onset zone using a responsive “closed loop” stimulation to control seizures. The components of this stimulator are a neurostimulator situated under the scalp connected to 1 or 2 depth or cortical strip leads. Each lead can be used for both sensing and stimulating. The physician programs detection and stimulation settings and retrieves and reviews data provided by the neurostimulator.

• Anterior Thalamic Deep Brain Stimulation (DBS) for Epilepsy

  This involves electrical stimulation of a deep area of the brain that acts as a “pacemaker” and can improve seizure control in certain types of epilepsy. This is done with real-time MRI guidance using our ClearPoint® MRI Interventions system.