North Shore-LIJ Epilepsy Center is Among the First in US and First in NY Metro Area to Offer Combined Minimally Invasive Surgical Procedures to Treat Epileptic Seizures
Contact: Michelle Pipia-Stiles
The Comprehensive Epilepsy Care Center at North Shore-LIJ’s Cushing Neuroscience Institute is one of the first in the United States and the first in the New York metro area to use a new combination of minimally invasive surgical techniques to treat epilepsy.
The procedures, called stereoelectroencephalography (SEEG) and laser ablation with use of a new MRI-guided thermal imaging and laser technology, were performed on 42-year-old Jack Ruiz from Westbury, NY.
“This option fits with our philosophy of curing epilepsy in intractable patients and making the difficult process of localizing and treating the seizure onset zone more accessible and less traumatic to patients,” said Cynthia L. Harden, MD, North Shore-LIJ’s chief, division of epilepsy and electroencephalography.
Brain surgery is increasingly being used to control seizures when they occur repeatedly despite antiepileptic medications. The challenge is often in pinpointing seizure-producing areas of the brain. Since surface electroencephalography (EEG) electrodes can be imprecise in determining the exact location of seizure-producing brain areas, electrodes sometimes must be implanted in the brain. Usually, this entails performing a craniotomy procedure to implant grids of electrodes over the surface of the brain.
“Minimally invasive approaches are the newest trend in epilepsy surgery,” said Ashesh Mehta, MD, PhD, director of epilepsy surgery at North Shore-LIJ’s Comprehensive Epilepsy Care Center, who recently performed the SEEG and laser ablation procedures on Mr. Ruiz. “SEEG, which offers an alternative to craniotomy, is a minimally invasive surgical procedure that involves placing depth electrodes within the brain to precisely identify seizure-producing brain areas with minimal discomfort to the patient.”
During the SEEG procedure, the neurosurgeon places electrodes in targeted brain areas of the anesthetized patient through small, two-millimeter pinholes that allow seizures to be recorded directly from the brain. The patient is then observed in the EEG video monitoring unit for about a week to determine the exact origin of seizures.
“Once we are able to reveal the abnormal brain areas that are causing a patient’s epilepsy, a second surgery can be performed to remove those pathological brain areas and render the patient free of disabling seizures,” said Dr. Mehta. “In Mr. Ruiz’s case, his seizures were located in the mesial temporal lobe and as such, he was an ideal candidate for the laser ablation procedure which is another minimally-invasive laser-based surgery to disable seizure-producing areas of the brain.”
In the laser ablation procedure, a one-quarter-inch incision is made through which the laser probe is placed and it delivers energy to heat the diseased, seizure-producing regions deep within the brain. The treatment is focused and MRI temperature maps provide neurosurgeons with a real-time view of the disease tissue being destroyed, while ensuring that normal, healthy tissue is spared from damage. The laser probe is then removed and the small incision is closed. Patients who undergo traditional open craniotomy typically spend three-to-four days in the hospital with a three-to-six week recovery period. On the other hand, after the minimally invasive laser ablation procedure, patients typically go home the following day and recover much faster.
“By combining SEEG and laser ablation procedures in a patient such as Mr. Ruiz, it is possible to achieve a seizure-free outcome without having to undergo a bigger surgery involving craniotomy,” Dr. Mehta said. “This combined treatment approach is ideal for patients who have seizures arising from deeper areas in the brain and those who are reluctant to proceed with a craniotomy procedure.”
About North Shore-LIJ’s Comprehensive Epilepsy Care Center:
The Comprehensive Epilepsy Care Center is a truly integrated and multidisciplinary endeavor, with epilepsy doctors, nurses, pharmacists, neurosurgeons, neuropsychologists, social workers, technical staff and an administrative team, all working together to provide care and support for patients with epilepsy. It is the largest and most comprehensive program on Long Island for the evaluation and medical and surgical treatment of epilepsy. Patients and families benefit from a unique and multidisciplinary model of care, integrating the expertise of clinical staff and the availability of cutting-edge technology to enable accurate diagnosis, effective treatment and improved quality of life. For more information about the Comprehensive Epilepsy Care Center, go to neurocni.com or call (516) 325-7060.