At Ascension St. Vincent’s Riverside, lasers are being used to treat brain tumors and epilepsy. The technique also allows for deep-brain stimulation procedures to treat tremors.
Dr. Aristotelis Filippidis, who heads the hospital’s brain tumor program, has been treating tumors deep inside the brain using laser interstitial thermal therapy (LITT).
The technology, which Filippidis started using about a year ago, allows him to place a laser near a tumor and use it to stimulate the body’s immune response system to attack the tumor.
For the procedure, he uses medical robotic equipment to make an exact placement of the laser.
This is a more precise and less invasive method than previous methods. Before lasers, a portion of the skull would be removed to allow access to tumors closer to the outer surface of the brain. Those deeper in the center were more dangerous to remove.
“It’s all about real estate, right? I can reach any part of the brain, as deep as I want, but you have to justify the cost of the real estate that you go through,” Filippidis said. “So with the laser, it’s like you don’t have that issue.”
Much of the work begins before the day of surgery. MRI scans allow Filippidis to plan the operation, informing him exactly where to make the less than 4 millimeter incision to allow access to the brain.
Ideally for the operation, a tumor would be about 3.5 centimeters, Filippidis said. Larger tumors may necessitate more than one incision to allow the laser to treat more surface area.
“There’s some evidence that it works like an internal vaccine. After we burn the tumor, the antigens of the tumor are presented to the immune system of the brain, and the brain attacks it,” Filippidis said.
This can be followed up with radiation or chemotherapy treatment if the tumor is cancerous.
Those with epilepsy can be treated by LITT as well. Patients who are on two or more epilepsy medicines but are still having seizures are candidates for the treatment.
Lasers burn the area of the brain that cause seizures. Filippidis said the method can greatly reduce the number and severity of the seizure events or can leave the patient free of them altogether.
Traditional brain surgery involved the patient being in intensive care for a week. In some cases, patients were placed in a medically induced coma.
The LITT operation can take as little as 30 minutes. Many times, Filippidis said, the patient goes home the day after the procedure.
“How do I feel the day of surgery? Calm. This is what neurosurgeons do. They don’t prepare the day of surgery, we have our plans. We have great backup plans. The day of surgery, we just execute the plan,” he said
Filippidis trained at Beth Israel Deaconess Medical Center in Boston and Barrow Neurological Institute in Phoenix. Barrow is the top-ranked neurosurgical institute in the world, Filippidis said.
In developing the brain tumor program, Ascension St. Vincent’s provided Filippidis with the equipment on which he had trained on at Barrow.
“Brain surgery is used as a phrase to say that’s something extremely difficult. Now I can’t use it. I can now say ‘rocket science’ for me,” Filippidis said.