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Pediatric Laser Ablation Surgery

Laser ablation is a minimally invasive brain surgery, which means children can recover and get back to normal activities much faster than with traditional brain surgery. Children’s Health is home to some of the nation’s top experts in laser ablation for children and teens.

What is Pediatric Laser Ablation Surgery?

Sometimes, it’s important to consider brain surgery to help your child get back to being healthy. For instance, when a child has epilepsy that doesn’t respond to medication, your doctor may recommend surgery to remove the part of the brain that is causing their seizures. Brain surgery can also be necessary to remove a small brain tumor.

Laser ablation is a precise type of surgery that can wipe out brain tumors and reduce or stop your child’s seizures. With laser ablation, also called laser interstitial thermal therapy, a neurosurgeon uses a small laser to burn away (ablate) cells in the brain. The procedure is guided by an MRI, which is a scan that allows us to see inside your child’s brain. This enables us to be sure we attack the exact part of the brain that is causing your child’s health issue.

Laser ablation is a minimally invasive alternative to traditional open brain surgery, which involves opening the skull and using surgical tools to cut out parts of the brain.

How does Pediatric Laser Ablation Surgery work?

The first step is to place tiny wires in the part of the brain we aim to burn away (ablate). There are lasers at the end of these tiny wires. The neurosurgeon places the wires using either the advanced ROSA™ robotic surgical assistant or a device called a stereotactic frame.

After the neurosurgeon inserts the wires, we use an MRI to confirm the lasers are in exactly the right place. Then the surgeon turns on the lasers to burn away (ablate) a small piece of brain tissue. The team uses MRI scans to monitor the procedure and make sure it goes as planned.

At Children’s Health℠, our team includes renowned pediatric neurosurgeons who are on the faculty at UT Southwestern. This gives your child access to some of the world’s top experts in laser ablation and many other types of procedures.

What are the benefits of Pediatric Laser Ablation Surgery?

This approach has many benefits, including:

  • Quick recovery. Most children who receive laser ablation surgery only spend one night in the hospital, and many don’t go to the ICU after the procedure. In contrast, traditional brain surgery usually requires three to five days in the ICU following surgery and a much longer healing time.
  • Pinpointed treatment. Laser ablation surgery is extremely precise, which means we can safely address brain tumors or parts of the brain causing epilepsy, with minimal impact on other parts of the brain.
  • Accessible to more children. Laser ablation makes it possible to treat some children who couldn’t be treated by open brain surgery. Because the laser is so precise, the neurosurgeon can reach parts of the brain that were otherwise impossible to operate on. This enables more children to get the treatment they need.

What are the side effects of Pediatric Laser Ablation Surgery?

After the laser ablation procedure, your child is given a steroid to reduce swelling and help with the recovery process. The steroid can have side effects, such as digestive issues like an upset stomach. Your child may also be tired after surgery as they heal from the procedure. But these side effects are minimal compared to the side effects of open brain surgery.

What are the risks of Pediatric Laser Ablation Surgery?

Laser ablation surgery has a very positive effect on most children, by burning away dangerous tumors or parts of the brain that cause epilepsy. But, because the laser is so small and pinpointed, there is a risk that it won’t get rid of all unwanted cells. Some of those cells may still be in the brain following the procedure. In that case, your child may need another surgery to target those cells. (This can also happen with traditional open brain surgery.)

With any brain surgery, there is a small risk of a stroke or infection. Our neurosurgeons will extensively evaluate your child before surgery to minimize these risks.

Depending on the part of the brain the neurosurgeon is operating on, there is a risk that surgery could impact some of your child’s normal brain functions. In that case, your child might need therapy to help them restore that function. Your neurosurgeon will prepare you for this risk in advance and explain the type of therapy that could be needed.

Children’s Health performs more pediatric laser ablations than almost any center in our region. This gives us the experience to understand your child’s risks and keep them to an absolute minimum.

What to expect with Pediatric Laser Ablation Surgery?

Laser ablation surgery is minimally invasive and usually requires a single night stay in the hospital. Here’s what to expect.

What to expect before laser ablation?

Your child will have a full evaluation one to two days before the scheduled laser ablation surgery to confirm that moving forward with the procedure is safe for them. Our neurosurgery team will thoroughly analyze your child’s blood work and medications. Some children will require pretreatment with a steroid (anti-brain swelling medication) to prepare their brain for the laser ablation.

At this evaluation appointment, our team will explain when your child must stop eating or drinking before the procedure (usually by midnight the night before). They will also give you a special soap and brush to clean your child’s hair before the surgery. This reduces the risk of infection.

What to expect during laser ablation?

When you and your child come to the hospital for the surgery, our team will prepare your child for the operation. The procedure usually takes seven to eight hours and your child will be put to sleep with general anesthesia.

After the procedure, your child will be moved to recovery and you’ll be able to stay with them there. They’ll receive a steroid to reduce swelling and help with recovery. Most children are able to have dinner with their family in their hospital room and go home the next day.

What to expect after laser ablation?

Your neurosurgeon will evaluate your child two weeks after the surgery. After the evaluation, our team will continue to provide the care your child needs. If your child had a brain tumor, your neurosurgeon will monitor your child with follow-up MRIs. If your child has epilepsy, they’ll continue to see their primary epileptologist to manage their medication and treatment to help them live their happiest, healthiest life.

Frequently Asked Questions

  • How big are the incisions for laser ablation?

    The incision is smaller than half an inch. Your child may need more than one incision. The neurosurgeon will remove a small area of hair (smaller than the size of a dime) for each incision. The hair will grow back.

  • Is there a chance my child will outgrow their epileptic seizures? Should I wait to do this surgery until they are older?

    When our expert team recommends laser ablation surgery, they’ve evaluated all other treatment options for your child. It’s extremely unlikely your child will outgrow the seizures. Without surgery, the seizures could spread to other parts of the brain. If the seizures spread, it can be harder to treat epilepsy with surgery.

  • After the procedure, will my child with epilepsy still need to take antiepileptic medication?

    Yes. After laser ablation surgery, the brain is healing and it’s necessary to keep the medication consistent. Your epileptologist will continue to monitor your child and reassess medication within two years after surgery.

    It is very important for your child to continue taking their seizure medications after surgery in order to allow the brain to heal from their surgery (even if they aren’t having seizures). If your child is seizure-free after one year, your neurologist will discuss with you whether changes can be made in the seizure medication dosages.