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Meet the Robot Giving Hope to Kids with Epilepsy

A robotic “arm” is leading to safer surgery and faster recoveries.

A nurse and a young patient are holding hands while walking down a hospital corridor.
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There are nearly 500,000 children in the U.S. living with the seizure disorder known as epilepsy. For children, epilepsy is more complicated than it is for adults and potentially more harmful—seizure activity is often found in more than one part of the brain and can be part of many different syndromes or conditions. And it is critical to control seizures in children to not only ensure their safety and improve their quality of life, but to protect normal cognitive development, as untreated seizures can lead to developmental delays.

For about two-thirds of children, medication can eliminate or control their seizures. But a third will experience refractory epilepsy, which does not respond well to medication. In these cases, surgery is a more effective treatment.

I am excited to be a part of the first pediatric program on Long Island (at Northwell Health’s Cohen Children’s Medical Center) to offer ROSA, a new technology that makes surgical treatment of epilepsy safer and more tolerable for children. ROSA stands for robotic operating surgical assistant and involves a robotic arm that is able to precisely target suspected areas of seizure activity through small incisions, eliminating the need to open the brain while trying to figure out where the seizures are coming from.

How is ROSA different?

Traditionally, surgical approaches to epilepsy involved a craniotomy. Surgeons would remove a large portion of the skull in order to access potential areas that might be affected by the epilepsy. Then we would place grids with electrodes on the surface of the brain to monitor electrical activity. The patient’s skull remains off for up to a week while the electrodes gather information. This was obviously incredibly hard for the patient and puts them at greater risk for infection and other complications.

ROSA is extraordinary in that it is a minimally invasive procedure that enables us to target suspected areas of seizure activity and monitor them more effectively to decide the best course of treatment. It makes the initial phase of discovery much less painful, with less blood loss and complications and quicker recovery. It also means that a patient can have a normal life between the exploratory procedure and any surgical treatment.

How does it work?

First, we analyze data from imaging studies such as MRIs, CT scans, and PET scans, as well as neurological testing and symptoms, to develop a hypothesis of where the seizures are originating in the brain. ROSA’s surgical planning software then helps us create extremely accurate three-dimensional maps of the brain.

In the operating room, we make small incisions in the scalp and tiny holes in the skull to access the brain. ROSA uses a laser to scan the patient’s anatomy and matches what it finds with the preoperative images. ROSA relies on a powerful navigation system—kind of like the GPS in your car—to move precisely inside the brain. The neurosurgeon controls the robotic arm and is able to perform complex maneuvers with complete control. Thin wires, known as depth electrodes, are then placed into the brain to more accurately detect and characterize seizure activity.

What comes after ROSA?

Once the electrodes are in place, patients are taken off any medications to allow for seizure activity. We want to see exactly how and where they are happening in the brain, so that we can perform a follow-up procedure to treat the affected areas. Because ROSA does not require the skull to be open, we have the luxury of time as we gather more information from the electrodes to create more targeted treatment. And the patient is able to have a more normal life as we collect data and prepare for the corrective surgery.

Once we have identified the areas of the brain where seizures are happening, we will schedule a follow-up surgery around six weeks later to treat them.

What does recovery look like?

Because ROSA is a minimally invasive procedure, recovery is much easier than with open brain surgery. Patients are usually able to enjoy dinner on the evening of their procedure. They will need to stay in bed as we watch for seizure activity, but they are usually able to go back to school or work within a week or two.

Next Steps and Useful Resources

  • Meet Dr. Shaun D. Rodgers, pediatric neurological surgeon.
  • Learn more about ROSA, the innovative new procedure that’s giving pediatric epilepsy patients an easier path to treatment.

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Published March 5th, 2019
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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