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Under The Laser

Local undergoes new surgery to help seizures 

Jack Ruiz had his first seizure when he was 17 years old. Since then, epilepsy has been a huge part of his life, as he’s suffered from disorienting seizures two or three times a week for over 20 years.  He was up to 13 pills a day, when he realized that something needed to change. 


Last week, Ruiz underwent stereoelectroencephalography (SEEG) and laser ablation, minimally invasive surgical procedures which will help treat his seizures. 


“I was up to 13 pills a day. That’s a lot of medication. I had to do something,” says Ruiz. “Things for me weren’t getting better so I said why not?  


The procedures were done at North Shore LIJ’s Comprehensive Epilepsy Care Center, which is the only place in the New York metro-area that performs these combined procedures. The procedures are not common, only about 100 laser

ablation procedures have been done in the United States.  However Dr. Ashesh Mehta, director of epilepsy surgery at North Shore-LIJ’s Comprehensive Epilepsy Care Center who performed the procedures on Ruiz, says that these minimally invasive approaches are the newest trend in epilepsy surgery. 


“It’s scary enough to have to undergo brain surgery, but if you can make it a smaller one with a quicker recovery, it becomes very attractive to patients,” he said. 


Typically when a brain surgery is done to control seizures, an intrusive craniotomy must be performed to implant EEG electrodes over the surface of the brain to find the precise location of  the brain producing the seizures.  


The new procedure is much less invasive. During the SEEG procedure, the neurosurgeon places electrodes in targeted brain areas of the anesthetized patient through small, two-millimeter pinholes that allow seizures to be recorded directly from the brain. The patient is then observed in the EEG video monitoring unit for about a week to determine the exact origin of seizures. The laser ablation procedure is next. The laser probe is placed and delivers energy to heat the diseased, seizure-producing regions deep within the brain.  The treatment is focused and MRI temperature maps provide neurosurgeons with a real-time view of the disease tissue being destroyed, while ensuring that normal, healthy tissue is spared from damage.  The laser probe is then removed and the small incision is closed.  Patients who undergo traditional open craniotomy typically spend three-to-four days in the hospital with a three-to-six week recovery period.  On the

other hand, after the minimally invasive laser ablation procedure, patients typically go home the following day and recover much faster.


“By combining SEEG and laser ablation procedures in a patient, it is possible to achieve a seizure-free outcome without having to undergo a bigger surgery involving craniotomy,” Mehta said. “This combined treatment approach is ideal for patients who have seizures arising from deeper areas in the brain and are reluctant to proceed with a craniotomy procedure.” 


The procedure will not rid Ruiz of his seizures, however, they will make them much milder and less frequent, and allow him to take less medicine.  As he recovers from the procedure, he says he is happy with his decision.


“Down the road, my epilepsy might have gotten worse, so it’s better to do something about it now,” he said. “I’m happy with it.”