Surgeons at Henry Ford Hospital have performed the first two minimally invasive laser brain surgeries in Michigan – one for epilepsy and one to treat a brain tumor. And in both cases the patients went home the day after the procedure.
"These types of surgeries can be as effective as conventional brain surgery for select patients and certain tumors, with much less risk and side effects to the patient," says Steven Kalkanis, M.D., a neurosurgeon and medical director of the Center for Cancer Surgery at Henry Ford Hospital.
Conventional brain surgery typically lasts several hours, with partial skull removal and cutting through healthy brain tissue to reach the area needing treatment. After surgery, patients generally stay in the hospital for two to seven days and then are out of work for two to six weeks.
In the minimally invasive laser brain surgeries, a neurosurgeon inserts a laser filament within a thin, flexible cooling catheter into the patient's brain through a tiny (4mm) hole in the skull, while monitoring the procedure via Magnetic Resonance Imaging (MRI) scanner images in real time.
The laser can deliver extremely precise energy to destroy tumors and abnormal areas of the brain that can cause epilepsy. The MRI's special software makes it possible for the surgeon to measure the temperature in different regions of the brain, allowing the neurosurgeon to make sure the appropriate tissue is being destroyed and minimize damage to healthy tissue.
The MRI-guided laser ablation procedure takes approximately four hours and patients are usually discharged the next day from the hospital.
Epilepsy patient Norma Probe of Woodhaven was the first in Michigan to undergo a MRI-guided laser ablation. The procedure was performed by neurosurgeon Jason M. Schwalb, M.D., Surgical Director of the Comprehensive Epilepsy Center at Henry Ford.
At 64 years old, Probe has had seizures since she was in her 20s. Probe tried 10 different seizure medications, either alone or in combination, but she still experienced at least one seizure a month that affected her consciousness. There are an estimated 1 million Americans like Probe with drug-resistant epilepsy.
"I would go into a blank stare for a minute or two, than come out of it," recalls Probe, who has seven children and 12 grandchildren. "I couldn't drive or do anything by myself like swimming or taking a bath. I never knew when I might have a seizure."
Probe went home the day after her MRI-guided laser ablation. And in the four weeks since undergoing the procedure at Henry Ford Hospital, she has not had a seizure.
"The ability to monitor the temperature of different regions of the brain in the MRI scanner is a significant advancement, allowing us to preserve critical brain regions. We hope that this new procedure will give a comparable cure rate to open surgery with decreased risks and discomfort," says Dr. Schwalb.
The minimally invasive, laser ablation brain surgery was performed a second time, Nov. 15, on a patient with a brain tumor.
A resident of Detroit, 62-year-old Shal Washington-Phillips was diagnosed with ovarian cancer in 2010. She came to Henry Ford in May 2013 with blurred vision, headaches and dizziness. It was discovered that her cancer had metastasized to an area of the brain that could not be reached by conventional brain surgery. After stereotactic radiosurgery (a precise radiation treatment), she was determined to be an ideal candidate for laser tumor ablation.
"In this situation all other treatments had failed and surgery was not possible because of the tumor's location," says Dr. Kalkanis, who performed the surgery along with Dr. Ian Lee. "We literally had exhausted all options; this new minimally invasive laser surgery gave us the one option we needed to be able to treat this tumor and prolong life.
"The patient went home the morning after surgery, which would not have been the case if she had had conventional brain tumor surgery. Her headaches have significantly improved, and she is functioning at near-normal levels. This is an excellent outcome for a first procedure."
Washington-Phillips agrees: "I no longer have any hallucinations. The headaches have gone away and the pain in one of the arms is gone."
Henry Ford Hospital is one of just 25 centers in the U.S. that can perform this type of laser surgery on the brain.
The technology was developed by Visualase, Inc., a privately held company in Houston.