Laser ablation is a state-of-the-art technology that uses light energy to destroy dysfunctional or diseased brain tissue. It is a minimally invasive procedure that typically results in less postoperative pain and a shorter recovery time than traditional surgery—in fact, the incision is usually closed with a single stitch. It can even be used on targets deep within the brain that would be unsafe to access with traditional surgery.
At Columbia’s Laser Ablation Center, we use an MRI scanner during the procedure to ensure extreme precision.
When is Laser Ablation performed?
Laser ablation is often used to treat certain kinds of epilepsy and brain tumors. Since the tip of the laser heats a small area, it works best to treat small, focused lesions. At Columbia, we use laser ablation to treat conditions including mesial temporal sclerosis, hypothalamic hamartoma, cortical dysplasia, tubular sclerosis, and brain tumors such as gliomas.
Laser ablation is an especially outstanding option when the location of a lesion would make it unsafe or dangerous to reach with traditional surgery.
At the Laser Ablation Center, we have also used a laser ablation procedure called cingulotomy to treat chronic pain. In the future, we foresee using laser ablation as part of psychiatric neurosurgery treatment for conditions such as severe OCD and depression that have resisted all other forms of treatment.
How should I prepare for Laser Ablation?
Laser ablation is performed under general anesthesia. Usually, little or no hair needs to be removed. The entire procedure takes about four hours.
First, a stereotactic frame is placed onto the patient’s head, and an MRI scan is taken. Using the markings on the stereotactic frame and the MRI information, computer software creates a precise 3-D “map” of the brain with reference to the frame. The neurosurgeon uses this map to calculate the best, safest trajectory from the outside of the skull to the target area. This trajectory is manually dialed in to a surgical apparatus on the frame.
Then the surgeon parts the hair, makes a surgical incision in the scalp and creates a surgical opening in the skull called a burr hole. The burr hole is approximately the diameter of a pencil.
Using the apparatus on the frame and an apparatus attached to the burr hole, the neurosurgeon inserts a thin tube, approximately the diameter of spaghetti, through the burr hole. This tube is called the laser applicator. Once it is in place, the laser is threaded through the applicator and the stereotactic frame is removed.
Then the patient enters the MRI machine again. The surgeon uses the MRI images to confirm that the laser is placed correctly and turns the laser on for a “test burst” to further ensure accuracy. Then the surgeon turns on the laser for the ablation. The surgeon monitors live MRI heat maps to ensure that temperatures are in the desired range and that nearby healthy tissue is not affected.
A second applicator and laser may be used if the lesion is larger or oddly shaped.
Once the lesion is destroyed, MRI images are reviewed. Then the laser and applicator are removed. Typically, one stitch is used to close the incision.
How is Laser Ablation performed?
Make sure you understand the risks and goals of laser ablation for your particular situation. It may help to write down your questions as you think of them and bring the list to your appointment.
What can I expect after Laser Ablation?
How long will I stay in the hospital?
Patients usually return home the day after surgery.
Will I need to take any special medications?
Not necessarily. Pain medication may be prescribed as needed to manage discomfort. Not all patients require prescription pain medication. (The brain itself has no pain receptors, so the only discomfort tends to come from the small surgical incision.)
Will I need rehabilitation or physical therapy?
No rehabilitation or physical therapy is required. Patients are typically able to make a quick return to their normal work and leisure activities.
Will I have any long-term limitations due to laser ablation?
Like any surgical procedure, laser ablation has risks—discuss these with your doctor before the procedure. In general, no long-term limitations are anticipated after laser ablation.