Precisely controlled procedure with low risk
Across Germany, the necessary equipment for this special form of epilepsy surgery is only available in a few clinics and has not yet been used on small children. At Heidelberg University Hospital, the procedure is used in particular to treat malignant and deep-seated brain tumors and brain metastases. There are also other areas of application such as the treatment of movement disorders or – as in Kuzey’s case – epilepsy due to a benign tumor. Professor Dr. Martin Jakobs, head of the stereotactic neurosurgery section of the neurosurgery clinic at the UKHD, expects up to 30 operations per year for various diseases. “The possible applications of minimally invasive stereotactic neurosurgery will continue to develop, for example through targeted gene therapy for childhood Parkinsonism and other diseases,” says the neurosurgeon. “Stereotactic laser thermotherapy has the unbeatable advantage over similar procedures in that the laser catheter can be coupled with the magnetic resonance imaging scanner in our operating room. This means we can control the correct placement of the laser probe as well as the heat spread in the tissue very precisely and reduce the risk of side effects.”
The tumor that Kuzey suffered from is very rare: around one in 200,000 children is affected. The tumor was located in a centrally located area of the brain, the hypothalamus, and repeatedly triggered faulty electrical signals and thus epileptic seizures, which blocked the brain for the duration of the seizures. The boy then appeared as if he had disappeared or suffered fits of laughter. The sheer number of these lapses stunted his brain development and he struggled to learn to speak. “Unlike most other diseases that are associated with epilepsy, this tumor had a clearly localized origin that could be destroyed without destroying healthy brain tissue,” says Professor Dr. Steffen Syrbe, head of the pediatric epileptology section at the UKHD Center for Child and Adolescent Medicine, who looks after the boy and his family.
Waiting was not an option
The alternatives to laser therapy would have been a complex operation or a so-called radiofrequency ablation, in which the diseased tissue is heated and killed using concentrated radio waves. However, at two years old, the boy was still too young for both options. “Waiting another year would have meant several thousand more attacks for the patient and his family,” says Professor Syrbe. “The family therefore decided on this innovative procedure, which we at the Heidelberg University Hospital in the team of neuropediatrists and neurosurgeons can also very safely offer to younger children.”
Kuzey was admitted to the pediatric neurology ward for therapy. The procedure itself took around three hours in total, from the imaging for 3D surgery planning to the insertion of the laser catheter and the control MRIs. To do this, the neurosurgical team opened a hole in the boy’s skull that was just three millimeters in diameter. From there, the laser probe was guided down to the hypothalamus at the base of the brain. The actual thermotherapy, in which the tumor was heated and destroyed, lasted 20 minutes. This procedure was a resounding success for Kuzey: since then, not a single epileptic seizure has occurred. “This intervention was particularly successful because we obviously eliminated all areas that were responsible for the seizures. But even if we had just reduced the frequency significantly, it would have been a relief for the boy and his family. We are therefore very satisfied with the possibilities that this procedure offers,” says neurosurgeon Professor Jakobs. The health insurance company covered the costs of the procedure.
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