Hospital Participates in Study of Incisionless Form of Brain Surgery

It sounds like a medical protocol straight out of a science fiction movie: A brain tumor neatly eliminated with an incisionless form of surgery.
In 2017, Nicklaus Children’s Hospital care teams used magnetic-resonance guided focused ultrasound – an incision-free technique – to ablate centrally located brain tumors in two young patients experiencing tumor-associated seizures.

The first-of-their-kind procedures are part of an FDA-approved research study designed to demonstrate the safety and feasibility of focused ultrasound for the treatment of benign intracranial tumors in children and young adults between 8 and 22 years of age.
The procedures targeted benign hypothalamic hamartoma brain tumors using INSIGHTEC’s Exablate Neuro system. Performed in a magnetic resonance imaging (MRI) suite, the procedures used high-intensity focused ultrasound waves to precisely target and destroy targeted tumors in the brain. Magnetic resonance imaging provides high-resolution visualization of the patient’s anatomy as well as near real-time monitoring. This marriage of technology allows surgeons to precisely heat and destroy the target tumor, without impacting the scalp, skull or surrounding healthy brain tissue.

After the procedures, one performed on March 7 and the other on November 14, MRI scans of both patients showed complete ablation of the respective tumors. The patients were able to return home soon after their surgeries and both have reduced seizures, with the second patient being seizure free since January 2018.

Prasanna Jayakar, MD, PhD, Chairman of the Nicklaus Children’s Brain Institute, said, “The Brain Institute is very honored to have been able to partner with INSIGHTEC to conduct a study of the safety of this novel methodology in children. Our program has an extensive multispecialty team, all dedicated to innovating the safest, least invasive methods to offer a better future for children with brain tumors and seizure-causing brain tissue. It is our hope that this contributes to knowledge that leads to enhanced treatment for children worldwide.”
The medical and research team at Nicklaus Children’s is led by Dr. John Ragheb, Director Division of Neurosurgery; Dr. Travis Tierney, Principal Investigator; Dr. Ian Miller, Director of Epilepsy Program; the late Dr. Sanjiv Bhatia, neurosurgeon; Dr. Nolan Altman, Director of Radiology; Dr. Prasanna Jayakar; and Dr. Jennifer McCafferty, Director of Research, Miami Children’s Research Institute.
The study is funded by Nicklaus Children’s Hospital, with support from the Focused Ultrasound Foundation. 
“Expanding focused ultrasound’s reach into pediatrics is an important milestone for the technology,” said Foundation Chairman Neal F. Kassell, MD. “It has been proven safe and effective in ablating tissue in the adult brain for movement disorders, and it is being investigated for soft tissue tumors and painful bone tumors in younger patients. We look forward to continuing to work with Nicklaus Children’s and other sites worldwide to advance this innovative care for children.”

Hypothalamic hamartoma is a rare, benign (non-cancerous) brain tumor that can cause different types of seizures, cognitive problems or other symptoms. While the exact number of people with hypothalamic hamartomas is not known, it is estimated to occur in one out of 200,000 children and teenagers worldwide.

Drs. John Ragheb and Ian Miller with the focused ultrasound technology.