Stereotactic Laser Ablation

Manish Ranjan, MD
Pediatric Neurosurgery Fellow 2017-18
BARROW Neurological Institute at Phoenix Children’s Hospital

It is a great privilege to be part of and be the fellow at such a wonderful organization like BARROW Neurological Institute at Phoenix Children’s Hospital. The Institution is at the forefront of the medical care, education, research and innovation and the Neurosciences here lead the way. Phoenix Children’s Hospital is one of the largest free-standing children’s hospitals in the United States and is the first and only international training center for pediatric neurosurgery in the United States by the World Federation of Neurosurgical Societies (WFNS).

Originally from Madhubani, a small town in India, I have a specific interest in the surgical treatment of epilepsy and movement disorders.  Previously, I traveled all across the Indian subcontinent and then around the world in pursuit of excellence in restorative neurology/ neuroscience. I previously completed a dual fellowship in stereotactic and functional neurosurgery and epilepsy surgery from one of the world’s leading center in North America, the University of Toronto, University of British Columbia and University of Calgary and had a chance to work with Dr. Andres Lozano and Dr. Christopher Honey and Dr. Walter Hader. During that time, I gained the expertise in the surgical treatment of epilepsy and movement disorders and cutting-edge research experience but it was clear that those treatments were often lacking in children. With my extensive training and background in the field, the esteemed Barrow Neurological Institute at Phoenix Children’s Hospital gave me the excellent opportunity to excel and offer service in one of the newest technological advancements in the surgical treatment of epilepsy, the stereotactic laser ablation. The surgical epilepsy program is led by true leaders in the field, Dr. Angus Wilfong, one of the pioneers of stereotactic laser ablation (SLA) and Dr. P. David Adelson.

SLA makes the surgical treatment very patient friendly because of it minimally invasive approach through a small few millimeter opening of skin/skull and precise targeting of the diseased area. The diseased tissue giving rise to the child’s seizure or a tumor can be ablated or erased with the LASER (a kind of light source) and is visualized in real-time MRI guidance, minimizing error and maximizing the beneficial outcome. One of the major advantages of this technique is that it avoids conventional larger operations (craniotomy) and therefore recovery is much faster. Typically the procedure requires no or minimal hair removal and requires minimal stitch (typically just one dissolvable stitch). Patients typically recover from the surgery to their baseline on the same day with minimal pain and go home the next day.

I recently had the opportunity to participate in the treatment of a young boy, Nicholas**, who had refractory epilepsy due to a brain lesion in his hypothalamus, called a Hypothalamic Hamartoma (HH). He had had surgery previously but unfortunately, he had a recurrence of his seizures. At BARROW Neurological Institute at Phoenix Children’s Hospital, after an extensive multidisciplinary work up and epilepsy team discussion, he was considered a good candidate for SLA for his epilepsy because of the focal nature of his seizure network. Nicholas was treated with a minimally invasive SLA of his lesion that was causing his seizures to try and cure his epilepsy. Nicholas and his family were pleasantly surprised with his quick recovery from surgery and on the day of surgery itself, Nicholas was up and walking with minimal to no pain. He went home the next day with minimal pain medicine.  For Nicholas and other children like him and their families, SLA is a life-changing marvel of the newest neurosurgical tool with utmost precision but with a kindness. I and the rest of the team at BARROW Neurological Institute at Phoenix Children’s Hospital feel pride and excitement to be able to offer cutting-edge technology and service to kids with epilepsy restoring their lives and providing support to their families.

I am glad that my journey to excellence has lead me to a very meaningful and satisfying course to a top-notch institution like BARROW Neurological Institute at Phoenix Children’s Hospital and more importantly an ability to heal children with refractory epilepsy, restoring their and their family’s lives with the latest neurosurgical innovations. For me personally, the opportunity to train at a world-class institution like BARROW Neurological Institute at Phoenix Children's Hospital is a great privilege that will provide me the training and expertise to provide expert care for others in the future.   

** Not his real name

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