Neurosurgical interventions pursue two aims: removing pathological loci in the brain and preserving healthy surrounding nervous tissue. Only combination of these two factors guarantee success of the procedure and the absence of complications.
The magnetic resonance imaging (MRI) is an extremely helpful technique that is aimed at investigating structure of the brain and detecting harmful changes. Now this technique is an integral part of the cutting edge intervention – MRI-guided laser ablation with the help of Visualase™ system.
High-tech Visualase™ system makes complex neurosurgical procedures much more comfortable for patients. Once a doctor recommends that you undergo brain surgery, you should definitely check to see if this technique is suitable to your medical case.
How does the Visualase™ system work?
MRI-guided laser ablation consists of a few consecutive steps. The first one is the stereotactic procedure – taking detailed 3D scans and determining the exact localization of the abnormal brain region. In contrast to the usual 2D images, stereotactic frame provides the doctor with the stereoscopic picture and, thus, more comprehensive information. This is called “neuronavigation”.
Once stereotactic coordinates of the targeted cerebral region are determined, a doctor proceeds to the intervention itself. In order to access the brain, the surgeon carefully makes a tiny (3.2 mm in diameter) hole in the skull. The laser catheter enters the skull and makes its way to the targeted region. The small size and flexibility of the catheter are significant for preserving healthy brain tissue in this way.
When the catheter reaches the targeted area, the laser inside it starts releasing energy. Due to this, the targeted tissue is gradually warmed up and destroyed. The neurosurgeon monitors the process with the help of real-time MRI scans. Doctors control the intensity and duration of the laser work. Specific MRI thermographic images also show the temperature of nearby tissues – it is substantial for protecting vital regions of the brain.
Finally, when the active part of work (thermal ablation) is completed, the surgeon gently removes the catheter and fixes the defects of the skull and overlaying skin. The patient returns to his ward and stays under medical supervision for at least a day. Usually the procedure is well-tolerated, so a patient can go home the next day.
Video: (c) Beta Klinik Bonn
Why the Visualase™ system is recommended for patients by doctors?
The Visualase™ system combines advantages of precise neuronavigation and state-of-the-art technical advances, leading to the following benefits:
1. Using the smallest ever neurosurgical catheter with a diameter of only 1.65 mm. The thin and flexible catheter moves through the nervous tissue easily and carefully, allowing a surgeon to work in the most hard-to-reach brain regions.
2. Naturally, this leads to the next advantage – almost invisible skin incision and tiny hole in the skull bone. Skin incision usually requires only one suture to be completely fixed. The diameter of the skull perforation is only 3.2 mm.
3. Using Visualase™ system offers the opportunity to reduce or totally avoid hair removing. You will not be embarrassed by your appearance after the intervention and choose a headwear only in case you like it. Later, the diminutive postoperative scar will be completely hidden by the hair.
4. Visualase™ makes serious neurosurgical interventions much easier for the patients. There won’t be any blood loss, dizziness or constant pain. You will be able to leave the hospital and go home the next day after the operation.
5. Excellent visualization during the procedure gives doctors and patients the possibility to avoid removing vast skull flaps. MRI substitutes direct field of view, giving even more detailed images.
6. Postoperative irradiation of the head is not performed as well, because the tumor or the pathological loci are thoroughly destroyed. At the same time, neighboring tissues remain viable, as the process of thermal ablation is controlled perfectly.
When can I choose this type of treatment?
The Visualase™ Thermal Therapy System is able to destroy soft tissues with the extremely high precision. The possibility of performing controlled ablation makes this technique optimal in terms of removing or destroying the tiniest undesirable changes in the brain.
1. Brain tumors, including gliomas, glioblastoma multiforme, anaplastic astrocytomas and radiation-resistant tumors and inoperative tumors in the hard-to reach regions are perfect candidates for this technique. The small size of the neoplasm is not an obstacle, as well – preliminary stereotactic marking makes it clearly visible during the surgery.
2. Epilepsy, namely, drug-resistant mesial temporal lobe epilepsy. This is the most widespread type of partial or localization related epilepsy, detected in one-third of all patients. The constant epileptogenic locus in the brain tissue causes seizures, which can’t be alleviated with any number or type of anti-epileptic drugs. Directly destroying the pathologic locus is the only effective cure for such a disorder.
3. Metastases of diverse tumors in the brain. Infection of the cerebral tissue with metastases of distant tumors is no less dangerous than the development of the primary neoplasm. MRI-guided laser ablation with the help of Visualase™ system offers the chance to destroy the smallest loci of the unwanted tissue.
In addition to neurosurgery, the technology of MRI-guided laser ablation can be used in other areas of medicine: cardiovascular surgery, ear-nose-throat surgery, head and neck surgery, gynecology, urology, and radiology. New ways of application are being elaborated and investigated in the clinical trials. For example, Visualase™ system can be helpful in removing radiation necrosis focuses formed due to prior radiation therapy.
This is a quite a new method, is it safe and tested extensively?
Elaborating new neurosurgical technique and implementing it into the clinical practice require the best efforts of engineers, radiologists, surgeons, and neurologists. Between the idea of new treatment options and its practical realization can take years of intense work. Only reputable medical communities are authorized to estimate all benefits and risks of innovative approaches.
First, MRI-guided laser ablation with the help of Visualase™ system received clearance of Food and Drug Administration (FDA) in July 2007. FDA is a federal agency of the USA Department of Health and Human Services. This is one of the world’s most reliable and qualified organizations, responsible for quality management in the sphere of healthcare. Approval by FDA means that drugs and medical equipment can be used without any doubts.
After that the pivotal clinical trial SLATE (Stereotactic Laser Ablation for Temporal Lobe Epilepsy) has started. The trial involved adult patients with temporal lobe epilepsy and was aimed to evaluate the risks and benefits of using the Visualase™ system for improving their clinical condition. The results were remarkable, so the technique is now a highly recommended treatment option for patients with drug-resistant temporal lobe epilepsy.
Finally, MRI-guided laser ablation with the help of Visualase™ system won CE Mark approval in the European Union in April 2018. This confirms conformity of the treatment technique with the highest health and safety standards. Luckily, more and more people are able to receive such a specialized therapy now. Some patients willingly share their thoughts and feelings online after the receive treatment. For example, the story of Nick Pauly, who has suffered from seizures for more than 30 years prior to successful therapy, now gives hope to other potential patients.
Does the Visualase™ system have any limitations?
MRI-guided laser ablation with the help of Visualase™ system is a well-tolerated procedure. Nevertheless, there are several limitations and even strict contraindications to this intervention. The most important of them are listed below.
1. General contraindications to MRI. Absolute contraindications include the presence of metallic implants in the body (e.g. coronary and peripheral artery stents, prosthetic heart valves, cochlear implants, and gastric reflux devices), implanted pacemakers or defibrillators, tattoos and cosmetics with particles of metals, claustrophobia, etc.
2. Long-term intake of certain medications. For example, this concerns Avastin (bevacizumab). The drug is used for the treatment of glioblastoma, including recurrent forms of the disease, metastatic cervical and colorectal cancer. The patient will need to exclude this medication once the treatment with the help of the Visualase™ system is planned.
3. Low availability of the equipment and qualified specialists. Even more significant restriction is the limited number of hospitals that offer such cutting edge expensive equipment and properly trained neurosurgeons. Patients with brain lesions often need urgent help, but long waiting lists postpone the procedure for months.
Patients always take into consideration prices of different treatment options. This is quite natural, as neurosurgical interventions usually have rather high costs and need additional negotiation with an insurance company. Fortunately, MRI-guided laser ablation with the help of the Visualase™ system is covered by most insurance companies. After all, giving preference to the minimally invasive approach saves money due to shorter inpatient treatment, better outcomes, and minimal risk of complications.
Where is the Visualase™ system available?
Before April 2018, interventions with the help of Visualase™ system were practiced only in large hospitals in the USA. The general number of such procedures was limited to a few hundred per year. Only US citizens were eligible to receive this innovative treatment.
The situation changed dramatically once the Visualase™ system received CE Mark approval in the European Union. Leading European hospitals quickly realized the benefits of this technique and began to apply it to patients who needed it. Thousands of people have received this high-tech treatment since then. And what is even more important, certain European countries are ready to help international patients along with their own citizens.
When we talk about treatment of foreign patients, the first place belongs to Germany. Compared to other European countries, Germany has the largest number of clinics equipped with the Visualase™ system. German neurosurgeons are qualified enough to perform hundreds of MRI-guided laser ablation procedures in patients with advanced brain cancer and epilepsy. For example, Beta Klinik in Bonn is famous all over the world due to the success in the treatment of epilepsy.
International patients can be admitted to specialized German clinics with the help of medical tourism operator – company Booking Health. Booking Health is the only company that has an international quality control ISO certificate in this field of work. The certificate confirms reliability and correspondence of the company’s service to the highest international requirements.
Booking Health offers help in such significant aspects, as:
- Choosing the right clinic based on the annual qualification profile
- Establishing communication directly with your doctor
- Preparing medical program in advance, without repeating previous examinations
- Providing favorable costs, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking an appointment on the necessary date
- Monitoring medical program at all stages
- Help in buying and forwarding of medication
- Communication with the clinic after completion of treatment
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Offering service of the highest level: booking hotels and plane tickets, transfer organization
To start planning your medical trip, you can check the information regarding relevant clinics on the website of Booking Health and send us your enquiry. Our patient case manager or medical advisor will contact you the same day to discuss all the relevant details. High-tech neurosurgical interventions with the help of Visualase™ system are now available for each person in need. This treatment offers a great chance to not only improve one’s health but also offers a better quality of life for patients.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova
Photo: (c) depositphotos