For only the second time in the world, doctors at the University of Chicago Medicine Comer Children’s Hospital and the Department of Neurosurgery used a minimally invasive surgery to disconnect the right and left sides of the brain and the left epilepsy-generating zones in a boy with epilepsy, stopping his seizures.
Neurosurgeon Peter Warnke, MD, performed the 8-hour laser functional hemispherectomy surgery in February 2021. The patient, 11-year-old Zachary Kurek, suffered a stroke at birth, causing him to lose most of the function of the left side of his brain. His epilepsy was getting worse as he got older, causing dozens of seizures a day that medication couldn’t control.
Anything startling, such as a loud noise or a barking dog, could trigger a seizure, causing his body to lock up and fall. He suffered countless bad bruises, a few broken bones and teeth, embarrassment, stress and the inability to do many normal activities. His mother said he was becoming depressed, angry and unable to sleep.
With Zachary facing a lifetime of these seizures and with very limited function in his left cerebral hemisphere as a result of the stroke, Warnke and his team studied the boy’s case. They determined that they could completely disconnect the right and left sides of his brain, and separate any epileptogenic tissue in the left hemisphere, without worsening his verbal or physical functioning.
That way, if seizure activity occurred in the left side of his brain, it would be unable to send signals to the right side of the brain or to the fibres that transmit seizure activity, and Zachary’s body wouldn’t react.
The surgery
A laser hemispherectomy is a highly com-plex, risky and challenging operation to help people with epilepsy. UChicago Medicine, which is a Level IV Pediatric Epilepsy Center, has performed about 250 laser surgeries, Warnke estimated.
But to completely disconnect a whole hemisphere with implanted laser fibres was a new challenge. Warnke and his team drew on their previous research, suggesting that interstitial lasers could be used to disconnect the two hemispheres of the brain.
“If we could replace open surgery with this, that would be a major breakthrough,” said Warnke, UChicago Medicine’s Director of Stereotactic and Functional Neurosurgery. “We’ve entered uncharted territory, but added a new level of safety as the surgery is carried out in the MRI scanner. It provides continuous vision and real-time monitoring of the brain temperature and imaging of the cell damage produced.”
“Where we’re at now is amazing,” said his mother Amanda Morey. “Not only have the seizures stopped, but his whole attitude has changed. He’s optimistic and happy now.”
Laser epilepsy surgery at Comer Children’s is now done using a new state-of-the-art robot. The robot is able to insert the laser fibres in the brain with greater speed and precision, shortening the surgery time.
When medications weren’t working, Julia Henry, MD, Zachary’s neurologist and epileptologist, told Zachary’s mother about different surgical treatment options available to him.
While a laser hemispherectomy might not be appropriate for every patient with epilepsy, Henry said the risk of death is less than 1%, and between 73% and 83% of children have their seizures cured by surgery.
“This surgery is a big and scary procedure. Disconnecting half my child’s brain? That’s a lot for any parent to process. But the results can be so dramatic,” Henry said. “The kids come to us so impaired. They have bad, frequent seizures. There are a lot of patients who might be good candidates for this, and this minimally invasive approach might open up the option for them.”
“There was so much that he went through, and I was very hesitant to do this surgery at first. I kept thinking about all the ‘what ifs’,” Amanda said. “Knowing what I know now, I wouldn’t have hesitated, and I wouldn’t have waited this long. It worked out perfectly for him.”
- For more information, visit https://uchicagomedicine.org/global.
