Resection vs Laser Ablation

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I’m going to have tests starting this Friday (an MRI and a vEEG) to look into doing a second surgery. I had a left temporal lobe resection in 1988 and the epileptologist I see at the University of Iowa Hospitals and Clinics (in Iowa City) is saying that she can see places that were missed in ‘88. The last MRI was done in 2003 though, so a new one will be done to see if it’s still operable or if it’s spread to areas that are unsafe to remove.

In Iowa City, the only option is a lobectomy/resection, but Mayo in Rochester MN is only 3 hours away and laser ablation is done there. It’s not as intrusive, but is it as effective? (The cuts were already made in 1988, so a lobectomy would be opening the same spots).

Note: I’ve been on several AEDs and have been doing the ketogenic diet for almost a year. I had 14 complex partial seizures throughout the last year. (None this year so far). I’m currently on keppra and my doctor is looking into getting me assistance for Vimpat. Fycompa is another consideration (with pharmaceutical assistance).

-Sandy


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Nakamova

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There are different individual factors that can make one type of surgery more appropriate than another, or more likely to be successful -- things like specificity of the focal area, the presence of scar tissue, etc. Laser Ablation is also a newer procedure, so there are fewer statistics on how successful it is over the long term. That said, one study (link below) at a single epilepsy center concludes that resection and stereotactic laser ablation (SLA) had similar seizure-free outcomes, but the SLA was the preferred technique because it had shorter lengths of stay.

https://www.ncbi.nlm.nih.gov/pubmed/29172137
 

Nakamova

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Cint

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Hi Sandinmyears,

I had a Left Temporal Lobectomy in 1990 and was seizure-free for 18 months. My seizures came back with vengeance. But after more drugs and testing, I wasn't a candidate for another temporal lobectomy, especially on the LEFT side. It is where the memory is stored, the left hippocampus..... so I would really weight the consequences of another brain surgery (on the left side). I now have the Vagus Nerve Stimulator. It doesn't completely control my seizures, but I wish I had that done instead of having my head cut open!
 
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