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The Cutting Edge

Minimally Invasive Procedure Puts End to Boy’s Rare Form of Seizures

  Cho family  
  Dr. Aria Fallah  
  skin incision  
  Dr. Fallah & Justin Cho  

Top: The Cho family, (clockwise from left) Robert, son Justin, wife So and daughters Katie and Kristen enjoy a board game at home. UCLA doctors used an optical laser to destroy a benign mass in Justin’s brain. Second: Using virtual-reality technology, Dr. Aria Fallah demonstrates the location of the hypothalamic hamartoma and its anatomical relationship to other critical structures of the brain. Third: The skin incision through which this surgery is done is invisible. Bottom: Dr. Fallah performs a follow-up neurological examination on Justin.

Photography by UCLA Health

Justin Cho is an engaging 9-year-old. Although he’s somewhat shy, he is quick to smile and has an infectious laugh. “Justin has always been a happy child — very energetic and bubbly,” says his father Robert Cho. “We assumed that giggling was just part of his personality.

What Robert and his wife So didn’t know was that the laughing fits Justin often had before bedtime actually were seizures and signs of a serious medical problem. One morning, as Justin was waking up, the couple saw him go into a full seizure. “We were terrified,” Robert Cho says. “Had we not witnessed it ourselves, who knows how long these would have gone on?”

The Chos brought Justin to UCLA Mattel Children’s Hospital, where he was treated by pediatric neurosurgeon Aria Fallah, MD. Justin had what’s known as gelastic epilepsy, which was caused by a benign mass called a hypothalamic hamartoma deep inside his brain, Dr. Fallah says.

Hypothalamic hamartomas are extremely rare, but if left untreated, they can affect a child’s intelligence and ability to learn, and they can cause premature puberty and death. The condition rarely responds to medication, which makes surgery the only treatment option. But the surgery most often used to correct the problem is particularly difficult because the masses are located deep inside the hypothalamus, the part of the brain that regulates hunger, thirst, body temperature and hormones.

“You couldn’t find a more challenging spot to treat in the human body,” Dr. Fallah says. “The hypothalamus is difficult to access, and it is surrounded by critical nerves, arteries, veins and neurological tissue that are vital to everyday functions.”

Removing a hypothalamic hamartoma typically requires open- brain surgery, in which surgeons remove a large section of the skull and slice open the brain to reach the lesion. The surgery leaves a large scar on the patient’s head, and, because the procedure is so invasive, patients generally remain in intensive care for up to a week and require months to fully recover. Side effects can include memory loss, hormonal imbalance and vision problems. Up to 10 percent of patients do not survive the surgery — a high figure compared with more common procedures. So Dr. Fallah and his colleagues used a cutting-edge technique designed to minimize the risks and dramatically speed Justin’s recovery. The approach uses heat from an optical laser to destroy the mass.

Surgeons made a 2-millimeter incision in Justin’s skull and, using GPS-like technology, mapped his brain and pinpointed the location and size of the hamartoma. Then, they fed a thin optical laser deep into the brain and penetrated the lesion. “Essentially, we cook the mass from the inside out,” Dr. Fallah says. “Once it’s destroyed, the epilepsy is gone.”

Although preparing for the surgery and mapping the patient’s brain can take several hours, the minimally invasive procedure itself takes only a few seconds, and the results last a lifetime. In Justin’s case, that meant getting back to playing soccer with his friends and sharing laughs with his family. “It’s a miracle,” Robert Cho says. “We’re so grateful we learned in time that Justin had this issue and that we found doctors who were able to treat it the way they did.”


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