Apr 4, 2024

A Minimally Invasive Procedure is Transforming Epilepsy Treatment

The Eastside Neuroscience Institute (ENI) now offers laser interstitial thermal therapy (LITT) – an innovative, minimally invasive procedure that uses a heated catheter to destroy problematic tissue in the brain. LITT can be used to ablate lesions that cause epilepsy, benign growths and malformations, and brain tumors – with less pain, fewer complications and much shorter recoveries than traditional craniotomy.

“If a patient has a tumor or epilepsy focus deep in their brain, LITT enables us to address it much less invasively than ever before, with far less likelihood of an adverse event. Most patients are out of the hospital and feeling back to normal within one to two days,” says Ryder Gwinn, MD, a neurosurgeon at ENI and EvergreenHealth.

Case Study: Ablating a Cavernous Malformation

LITT involves inserting a laser catheter through a small incision (typically about 2 mm) in the skull and guiding it to a specific area in the brain. The tip of the catheter is then heated until the heat destroys the tissue being targeted. LITT was approved by the FDA for neurosurgery in 2007 and is offered at more than 100 centers nationwide.

We recently used LITT to help a 35-year-old male patient who was referred from the Emergency Department after he suffered a grand mal seizure while playing basketball. Imaging revealed a cavernous malformation in the posterior temporal region near visual pathways.

Caption: MRI image revealing a cavernous malformation.

“We talked to the patient and presented him with a choice between the traditional surgical approach and LITT – and, like most patients, he really appreciated that we could offer a minimally invasive option that could address his problem with a very short recovery,” Dr. Gwinn says.

The laser catheter was placed in the operating room with the assistance of a cranial robot and intraoperative imaging machine to verify accurate placement. The patient was then transferred to the MRI suite while under anesthesia, where the treatment was performed. He did very well throughout the treatment, spent one night in the ICU for observation, and was discharged the next day.

Caption: Operative placement of LITT fiber

Like most LITT patients, he experienced minimal pain, quickly got back to his normal activities and has been seizure-free in the four months since his procedure.

“This shows the advantages of LITT for patients who are good candidates,” Dr. Gwinn says. “With a traditional craniotomy, this patient would have spent several days in the hospital, needed narcotics to manage the pain and been told to avoid strenuous activities and heavy lifting for six weeks.”

How MRI Improves LITT Safety and Efficacy

We perform all LITT procedures in our MRI suite. This enables our team to monitor the procedure and the patient’s brain in real time, which helps ensure that we target the correct location and avoid tissue that’s essential to protect.

During the procedure, we use a pre-operative MRI to zero in on the part of the brain where we place the catheter. We then utilize MRI thermography during the treatment to see how far the catheter’s heat reaches and monitor the exact temperature of each brain pixel. The therapy automatically stops if the temperature approaches predetermined limits.

“The MRI enables us to be sure each procedure is as safe and precise as possible,” Dr. Gwinn says. “Then, once we’re finished, we can immediately use the MRI to confirm that there’s no bleeding or other adverse events.”

Avoiding Complications of Epilepsy Surgery

For lesions that cause epilepsy, LITT can stop seizures with roughly the same success rate as traditional surgery, but with fewer long-term side effects.

“Traditional surgery has historically been the most effective way to stop medically refractory seizures, but it too often impacts other tissue and affects brain function,” Dr. Gwinn says. “The literature suggests LITT can be almost as successful at stopping seizures, with a better safety profile.”

Dr. Gwinn used LITT for more than a decade before he joined ENI and Evergreen. Now he’s excited to bring its benefits to patients on the East Side, as part of our effort to continue combining world-class expertise and technology with a care philosophy that puts patients first.

“Our whole care team is oriented around the patient – not around the doctor and not around the therapy,” Dr. Gwinn says. “In my experience, that’s very unique and it’s wonderful – it’s the best part of being here.”

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To refer a patient:

Bellevue Location 1-425-635-6560

Kirkland Location: 1-425-899-3135

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