CNN has the story of Cara Pressman, a 15-year-old that is one of the roughly 40 percent of a epilepsy sufferers for whom medication has not been able to help. In some of these kinds of cases there have been high success rates in treating certain areas of the brain that seem to be most affected by the neurological disease via surgery. Pressman had been hoping to get laser ablation surgery, a minimally invasive procedure that has shown a high rate of success in helping to relieve many of the problems people like Pressman face.
Cara Pressman sobbed in the big red chair in her living room. The 15-year-old tried to absorb the devastating news relayed by her parents: that their insurance company, Aetna, denied her for a minimally invasive brain surgery that could end the seizures that have haunted her since she was 9 years old.
In the six weeks since the denial, Cara has had more than two dozen seizures affecting her everyday life. Her message to Aetna is blunt: "Considering they're denying me getting surgery and stopping this thing that's wrong with my brain, I would probably just say, 'Screw you.' ''
The third largest health insurer in the country’s “reason” for rejecting Pressman’s insurance request was:
"Clinical studies have not proven that this procedures effective for treatment of the member's condition," Aetna wrote in its rejection letter.
The insurance company did approve her for the more invasive and more expensive open brain surgery, called a temporal lobectomy, even though her medical team never sought approval for the procedure.
The temporal lobectomy is exactly the kind of surgery Ms. Pressman has been hoping to stay away from. And as Science Daily explains, there’s a reason more and more people are looking toward the less invasive laser ablation.
Until rather recently that meant a craniotomy -- a conventional, day-long operation involving removing part of the patient's skull, cutting through healthy brain matter and physically taking out the problem tissue, followed by a weeklong hospital stay and a prolonged recovery period.
The MRI-guided laser ablation method is far less invasive and time-consuming. A thin laser-tipped applicator inserted through a tiny hole in the skull delivers heat to the target area in the brain and destroys the unwanted tissue with the neurosurgeon viewing and being guided by real-time MRI images throughout the operation.
The entire process can be completed in about four hours, the incision in the scalp can be closed with just one stitch and most patients can go home the next day and resume their normal activities without restrictions.
CNN spoke with a doctor at the Mayo Clinic who is not treating Pressman, but says calling the laser ablation surgery “experimental” is bogus.
"I would not call it experimental at all," said Van Gompel, who is leading a clinical trial on the surgery at Mayo as part of a larger national study. "It's definitely not an experimental procedure. There've been thousands of patients treated with it. It's FDA-approved. There's a lot of data out there to suggest it's effective for epilepsy."
And according to clinical trials, the success rate of the riskier temporal lobectomy is “slightly better,” but not enough to eschew the less invasive laser ablation. And there are other hospitals that haven’t even performed the temporal lobectomy since the laser ablation surgery became available to them.
Neurosurgeons performed the first MRI-guided laser ablation surgery for epilepsy at Wake Forest Baptist in 2012, using a technology called Visualase. Since then they have employed the system more than 45 times on patients ranging in age from under 18 months to over 60 years. The success rate of these operations, in terms of either eliminating seizures or reducing their frequency or severity, depending on the individual patient's condition, has been above 75 percent.
Popli called that a marked improvement over the 60 percent success rate of conventional epilepsy surgery, which, he noted, has not been performed at the medical center since it adopted the Visualase technology.
As Ms. Pressman said so eloquently. Screw you, Aetna. Screw you.