About 5% of those who get the surgery suffer permanent neurological deficits, the study authors said.
One of the children who had laser therapy died of brain swelling. In open surgery, between 0.4% and 1.2% die, depending on the location of the lesion being removed. The one death resulting from laser therapy is equivalent to 0.5% of patients, the findings showed.
Prior to laser therapy, surgery was the only option to potentially cure seizures. There are other types of treatment, Widjaja said, but they’re meant to reduce rather than cure seizures.
In the laser procedure, the surgeon makes a small hole in the skull. A thin laser fiber goes through that to the lesion — or the spot in the brain that is the source of the seizures. Laser heat energy burns the lesion. MRI is used to monitor the temperature and protect nearby brain tissue, the researchers explained.
With the surgery, the doctor makes an incision in the scalp and removes a flap of skull bone, cutting out the lesion and replacing the bone flap.
An advantage to laser therapy is that it can be used for lesions deep within the brain without as much injury to normal tissue, Widjaja said. It also has fewer complications, she said. The hospital stay after the procedure is two days, compared to seven days after surgery.
The most common lesions experienced by the study participants were hypothalamic hamartomas and focal cortical dysplasias.
The U.S. National Institutes of Health describes hypothalamic hamartomas as rare, tumor-like malformations. They are present at birth and can cause a variety of symptoms, including a type of seizure. Focal cortical dysplasia involves abnormal brain cell organization, according to the Epilepsy Foundation.
“It’s encouraging because minimally invasive surgery has fewer hospital days. There tend to be fewer complications. There is less infection. There is less stroke,” said Dr. William Gaillard, chief of neurology at Children’s National Hospital in Washington, D.C., and a past president of the American Epilepsy Society.
Gaillard thinks people don’t consider surgical procedures for epilepsy early enough. It is less likely for children that there will be neurological consequences that are behavioral and cognitive, he said. Becoming seizure-free can also mean more normal socialization, he added.
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