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September 20, 2013
Darryl Geddes 315 464-4828

Upstate Golisano Children’s Hospital is first to treat rare brain tumor with multi-staged approach using laser ablation technology

SYRACUSE, N.Y. — Physicians at Upstate Golisano Children’s Hospital in Syracuse, N.Y., are the first in the world to use minimally invasive MRI-guided laser technology in a multi-stage approach to treat a rare, sometimes life-threatening genetic disease called tuberous sclerosis, which causes non-cancerous tumors, called tubers, to grow in the brain leading to a host of symptoms. Doctors at Upstate also have used the technology to successfully treat epilepsy and other brain-related disorders.

Known as MRI-guided thermal laser ablation, the treatment enables doctors to insert a small laser into the brain to eradicate the tumor or the epilepsy focus using a burst of heat. This new surgical approach is safer for patients and significantly reduces complications and recovery time. Doctors no longer have to perform a craniotomy or use radiation therapy, which can damage surrounding tissue, and lead to extensive rehabilitation and lengthy hospital stay.

“With this new minimally invasive option, we are talking about bringing the patient to the hospital for a one-day procedure, with little disruption to the patient or the patient’s family,” said Dr. Zulma Tovar-Spinoza, director of pediatric neurosurgery at Upstate Golisano Children’s Hospital. “Results from the procedure are also immediate as noticed by improvement of symptoms among patients and families.”

While epilepsy and various brain tumors are the conditions most treated with this new procedure, Tovar-Spinoza and her team are among the few who have successfully used it to treat other disorders that relate to brain tumors, especially tuberous sclerosis and hypothalamic hamartoma.

Tuberous sclerosis is a genetic disorder that causes non-malignant tumors to grow on the brain and other organs causing seizures and developmental delays and a host of other ailments. Estimates are that tuberous sclerosis affects about 50,000 people in the United States and one million worldwide, with one in 6,000 children are born with the disease. Hypothalamic hamartoma is a non-malignant tumor that attaches to the base of the brain causing diminished cognitive ability, behavioral disorders, wild seizures and precocious puberty.

Writing in Child’s Nervous System, the official journal of International Society for Pediatric Neurosurgery and other worldwide pediatric neurosurgical societies, Tovar-Spinoza and her team highlighted a case involving a 3-year-old boy who had been diagnosed with precocious puberty at 10 months of age. Despite heavy doses of drugs, seizures marked by self-aggression, temper tantrums and hyperactivity, worsened. Doctors pinpointed a type III hypothalamic hamartoma and suggested treatment of the tumor with MRI-guided laser thermal ablation. Two weeks post-procedure, the family reported “significant improvement” of behavior. At six-months post procedure, patient is seizure free and enjoys long periods of self-play. The precocious puberty has been resolved six months after the procedure.

A short stay is all that’s needed

Before the procedure, patients undergo magnetic resonance imaging or MRI of the brain so doctors can see the size and location of the tumor(s) or lesions. Using special software, physicians identify the tissue to be targeted and create a surgical plan to eradicate the diseased tissue while avoiding healthy surrounding tissue.

On the day of surgery physicians place a special frame on the child’s head that enables doctors to make precise calculations of where to insert the lasers. A 3.2-millimeter hole is made in the patient’s skull in which laser applicators are secured. Once the laser applicator is inserted, the patient is transferred to the MRI unit, which allows the physicians to carefully monitor the treatment using special software. A bright orange glow shows on the computer terminal when the laser light destroys the tumor or target area.

Once the treatment is over and the laser applicator removed, doctors need only a small bandage and a single stitch to close the small incision where the laser application was inserted

In the more than handful of patients that Tovar Spinoza and her team have treated, there have been dramatic changes to the patient behaviors. 

Interest abounds

Tovar Spinoza’s work at Upstate has drawn interest from numerous organizations, including Hope for Hypothalamic Hamartomas (HH), a non-profit group aimed at raising awareness and supporting treatment options for patients and families affected by a benign tumor-like malformations that causes seizures.
“We’re very excited about this procedure; it’s a huge breakthrough for our patients and their families,” Miller said Ilene Miller, co-founder of Hope for HH. “It’s great to see physicians like Dr. Zulma Tovar-Spinoza and others in the neurological community embrace this treatment. It’s reassuring to have their skill and knowledge help us find a treatment for Hypothalamic Hamartomas. We hope to continue to see breakthroughs with this procedure.”

Miller says Tovar Spinoza will be part of the organization’s national network of doctors and researchers who are interested in getting more involved in issues related to HH. “We’re eager and interested to learn more about the successes these physicians have with this treatment,” she said.

The first one in the world

For one Central New York family, the use of MRI-guided thermal laser ablation has been a miracle for their daughter and the family.

Arianna Failla, 2, suffered from tuberous sclerosis and until her first procedure with MRI-guided thermal laser ablation, the seizures and disruptive behavior was unrelenting. Coupled with some developmental deficits, Arianna’s case was difficult for the family. On the suggestion of Tovar Spinoza, Arianna was a good candidate for laser ablation. Since the first procedure in February, the results have been inspiring.

Arianna is the first patient in the world treated with multi-staged laser ablation for tuberous sclerosis. Classically, open surgery will imply subsequent open procedures and long hospital stays and recovery. Now, with the protocol designed by Tovar-Spinoza and Dr. Yaman Eksioglu, director of pediatric neurology at Upstate Golisano Children’s Hospital, patients with tuberous sclerosis are offered a staged treatment without disrupting their lives. This protocol is enrolling patients and has a positive reception from the Tuberous Sclerosis Alliance organization.

“We have seen steady progress with Arianna’s behavior and her cognitive abilities,” said her mother, Jennifer Failla. “I’m elated with the results we see in my daughter; it has not been an easy go of things, but we see a brightening of her future and that is very promising.”
Jennifer Failla said minimally invasive nature of the procedure has kept the family together and kept her daughter from having to endure long hospitalizations and rehabilitation. “The procedure requires us to be in the hospital for only a few days, and that helps us have some sort of normalcy in our lives,” she said. “We also know that when my daughter completes a laser ablation procedure, there are not long hours of therapy required for her. She’s back home in what seems like an instant, especially for what some consider brain surgery.”

Tovar-Spinoza is eager to share the promising results with others around the world. Not only is she in demand for her surgical prowess with this new procedure, but medical institutions the world over are eager to hear from her on what this procedure might be able to do for patients suffering from other cognitive tumor-related disorders.
“This procedure is one of the most exciting breakthroughs in pediatric neurosurgery the medical community has seen in years,” she said. “We are seeing remarkable results for children with epilepsy and cognitive issues, and we’re just beginning to realize that the benefits could be far-reaching for many.”

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