Laser Interstitial Thermal Therapy (LiTT) has been used to treat drug-resistant epilepsy for the first time in Western Australia, providing a minimally invasive alternative to open brain surgery.
The method uses targeted laser energy and real-time MRI guidance to ablate brain tissue through a small hole drilled into the skull.
Neurosurgeon Dr Arjun Chandran brought this capability to Australia after gaining experience with it during fellowships at Memorial Hermann Hospital in the USA and SickKids Hospital in Canada.
The first operation using the LiTT therapy in WA was undertaken at Sir Charles Gairdner Hospital in May as part of a trial. It also happened to be a procedure that had not been carried out in the southern hemisphere before – a corpus callosotomy.
The operation involves cutting the thick band of nerve fibres connecting the left and right brain hemisphere (the corpus callosum) to prevent the spread of epileptic electrical activity between the two sides of the brain.
Dr Chandran explained how the method enabled the procedure to be carried out in a less invasive manner than traditional open brain surgery.
“You map out with a great deal of planning where you want the laser fibre to go and what you think that burn or ablation might look like,” he said.
“Then using a fancy GPS system in the operating room, you make a tiny stab incision in the scalp, the size of a scalpel blade, so three to four millimetres. After drilling into the skull, using that GPS system you pass the laser fibre where you want it to go.”
Dr Chandran said from there the patient was transported carefully from the operating room into the MRI scanner.
“We confirm that the laser fibre is where we want it to be and then we complete the ablation in real time in the MRI scanner,” he said.
Dr Chandran said there had been extensive planning ahead of this first surgery, including obtaining laser safety licenses
Prior to this surgery, a patient would have to travel to another part of Australia to have this type of operation as there were only three or four sites across the country using the technique in the past couple of years.
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He said this type of surgery reduced risks and recovery time.
“If we were to do it open, because the procedure is longer, it exposes the patient to the risk of infection because it is an open procedure and a larger incision.
“It is also highly dependent on the surgeon’s skills, operating around key structures, including the third nerve. It’s very close to the brain stem where we are operating, so it exposes patients to all the risks of an open craniotomy,” Dr Chandran said.
“Often we do this procedure on the dominant temporal lobe, so that can affect the patient’s speech or cognition just by operating and trying to get to the regions that we’re trying to reset,” he said.
“By doing this with laser fibre, we can avoid all of that risk.”
Dr Chandran worked with the patient’s neurologist Dr Josephine Chan, who had been managing the patient’s epilepsy for five years, to make the surgery a possibility.
The 18-year-old male patient had been having up to 10 ‘drop seizures’ a day.
“The patient was exceedingly debilitated by seizures that were causing him to essentially have drop attacks and fall to the ground,” Dr Chandran said.
“He was having up to 10 episodes per day where he was falling to the ground and hurting himself and was having recurrent presentations to the emergency department.”
Dr Chandran said the patient was able to go home two days after the procedure rather than the standard four or five, which would have been the case if it was an open surgery.
“He has not had any debilitating drop attacks since surgery, which is fantastic, and his parents say he is significantly more alert and interactive with them.
“They have noticed an overall reduction in all of his seizure types, not just the drop attacks.”
Dr Chandran said there would generally be about three or four cases which could benefit from a corpus callosotomy in WA each year and other epilepsy-related procedures that could be done using the LiTT method.
It has since been used in a second surgery performed by Dr Hari Ramakonar, who Dr Chandran worked alongside to establish the service.
Dr Chandran also recognised the support of Dr Sharon Lee, Head of the state-wide Neurological Service of WA, who had provided support to get up and running.
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