1. Health

Laser plus MRI equals less invasive brain surgery option

Dr. Fernando Vale of USF Health looks at images from an MRI in a Tampa General Hospital operating room.
Dr. Fernando Vale of USF Health looks at images from an MRI in a Tampa General Hospital operating room.
Published Apr. 21, 2014

TAMPA — For six years, Markus Muehlheim could keep his epileptic seizures under control with medication. They came on more than a year apart, each lasting less than 10 minutes.

But then the Spring Hill man began having seizures about every two weeks, landing him in the hospital every time.

"My life was very much affected by it," said the 69-year-old retired mechanical engineer. "I couldn't drive anymore. They came unannounced. It happened twice when I was in a restaurant."

In the past, his next step might have been open brain surgery, which usually requires a 2- to 3-inch incision in the head, removing and replacing a piece of bone, and weeks of recovery.

But now area doctors are using MRI guided laser surgery to treat some types of epilepsy and certain brain tumors, giving patients an alternative they didn't have before.

It's a welcome development for people like Muehlheim whose seizures are no longer controlled by medication, as well as for patients who for various reasons cannot have open brain surgery.

Laser surgery begins with a fingernail-size opening in the skull. The laser probe, thinner than a strand of spaghetti, is pushed directly into the area to be treated, then heat is applied, usually for a minute or two. The heat burns away small brain tumors and small areas of brain tissue responsible for some epileptic seizures. It is used along with magnetic resonance imaging, which helps guide doctors to the precise area to be treated and monitors temperatures so healthy brain tissue isn't damaged by the laser.

"This technology allows us to better define the area we want to treat," said Muehlheim's surgeon at Tampa General Hospital, Dr. Fernando Vale.

"It also allows us to be so specific to the target, that the heat does not spread to other healthy parts of the brain," explained Vale, who is chief of neurosurgery at TGH and vice-chairman of the Department of Neurosurgery and Brain Repair at USF Health.

After the procedure, the opening in the head is closed with a single stitch and a bandage. Patients typically go home the next day and are back to regular activities in a few days, versus two or three weeks with standard surgery.

Tampa General Hospital began offering the Visualase Laser Ablation System last fall to a select group of epilepsy patients. In early April, TGH invested $9 million to install an MRI in a special operating suite so the surgeries can be performed from start to finish in the same room.

At most hospitals, the procedure begins in the operating room where the skull is opened surgically. Then patients are moved to the MRI in another part of the hospital for the laser procedure. At Tampa General, this meant wheeling patients and the entire surgical team from the second floor to the first floor.

That shuffle was "a delicate procedure'' that added at least 45 minutes to the surgical time, Vale said. With the new surgical facility, he said, use of the laser will be expanded to include treating brain tumors.

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In the new setup, the MRI machine sits on a track behind a sliding door and glides in and out of the room at the touch of a button.

Moffitt Cancer Center acquired Visualase earlier this month and expects to begin offering it soon to patients with small, inoperable brain tumors. Patients will be shuttled between the operating room and the MRI suite a floor away. Dr. Arnold Etame, the neurological surgeon spearheading laser brain surgeries at Moffitt, thinks about 10 to 20 percent of his patients will be candidates for the minimally invasive option. The laser will not replace standard open brain surgery, but it will be a better alternative in some cases.

"Some patients are symptomatic, they have paralysis, speech or vision problems, but they are just not in good shape and are not good surgical candidates," Etame said. "It's a big deal to be able to offer them the laser."

Muehlheim had the laser procedure at Tampa General in January and has been seizure free ever since.

Muehlheim, who expects to begin tapering off his oral anti-seizure medication soon, hopes to eventually get back behind the wheel of his car or at least his tractor. Patients must be seizure free for six months to return to driving, and he is counting the days.

"I think it has cured me,'' he said of the surgery, "but time will show us.''


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