Abstracts

Rationale: The Visualase system has been FDA-approved for thermal ablation of soft tissue in neurosurgery since 2007. It has many theoretical advantages over conventional neurosurgical resection, including smaller exposure, shorter recovery, and less pain. The system also allows real-time MR guidance, which may further improve safety and surgical accuracy. Whether these benefits are observed in children undergoing epilepsy surgery has not yet been reported. Methods: Miami Children's Hospital began using the Visualase system in May, 2011. We report on the clinical history, surgical approach, and outcomes for all five patients with intractable epilepsy who have been treated using Visualase since that time. Intraoperative neuronavigation included both the Leksell Stereotactic System, as well as the Brainlab navigational system. Results: A total of five patients with intractable epilepsy underwent surgery at Miami Children's Hospital between 5/2011 and 6/2012. The mean age at surgery was 14.9 years (range 11.5 to 18), with the mean age of epilepsy onset of 7.6 years (range 4-10.7). Of five patients undergoing Visualase surgery, there were six total procedures. The only complication observed was placement-related: one patient was converted to conventional resection, one patient required a second Visualase ablation, and three were satisfactory. Mean length of stay was 1.6 days (range 1-2). The were no complications from infection, bleeding, or unintended neurological injury. Two patients were Engel class I (seizure free) after Visualase surgery, one of whom required a second Visualase ablation. In the remainder, one patient was Engel class III, one patient was Engel class IV, and the fifth patient was Engel class I following conversion to conventional resection. Conclusions: Minimally invasive epilepsy surgery in children is safe and effective. Length of stay is shorter than conventional surgery, and we experienced no unanticipated complications. The biggest factor determining success was precise placement of the laser fiber, and complete destruction of the epileptogenic zone. Visualase is a promising mode of treatment for intractable pediatric epilepsy; small, deep lesions (such as those seen in tuberous sclerosis) may be particularly amenable to this approach.