Applications of a robotic stereotactic arm for pediatric epilepsy and neurooncology surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The ROSA device is a robotic stereotactic arm that uses a laser system to register the patient’s head or spine with MR or CT images. In this study, the authors analyze their experience with this system in pediatric neurosurgical applications and present selected cases that exemplify the usefulness of this system.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed all cases that utilized the ROSA system at their institution. Patient demographics, pathology, complications, electrode placement, laser ablation, and biopsy accuracy were analyzed. Patient disposition and condition at follow-up were also analyzed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Seventeen patients underwent 23 procedures using the ROSA system. A total of 87 electroencephalography electrodes were placed, with 13% deviating more than 3 mm from target. Six patients underwent stereotactic needle biopsy, and 9 underwent laser interstitial thermotherapy (LITT). One patient who underwent LITT required a subsequent craniotomy for tumor resection. Another patient experienced an asymptomatic extraaxial hematoma that spontaneously resolved. No patient suffered neurological complications during follow-up. Follow-up from the last procedure averaged 180 days in epilepsy patients and 309 days in oncology patients.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The precision, ease of use, and versatility of the ROSA system make it well suited for pediatric neurosurgical practice. Further work, including long-term analysis of results and cost-effectiveness, will help determine the utility of this system and if its applications can be expanded.</jats:p></jats:sec>

Patient-Reported Functional and Satisfaction Outcomes after Robotic-Arm-Assisted Total Knee Arthroplasty: Early Results of a Prospective Multicenter Investigation

“…To minimize confounding bias, the study was designed to enroll the groups consecutively using identical selection criteria. Baseline characteristics including patient self-reported functional activity, satisfaction, expectations, and symptoms were indeed similar (►Tables [1][2][3][4][5]. Additionally, we compared the improvements in postoperative scores, a potentially more clinically relevant outcome, instead of simply comparing the postoperative scores.…”

“…Many recent advances in operative technologies have been introduced in the field of surgery. [1][2][3] Although robotics have been used in other specialties for more than two decades, it has only recently been more widely adopted in adult reconstructive surgery. [4][5][6][7] In total knee arthroplasty (TKA), the use of standard extramedullary and intramedullary guides has been the most common methods for achieving component alignment.…”

Laser Ablation of a Nonlesional Cingulate Gyrus Epileptogenic Zone Using Robotic-Assisted Stereotactic EEG Localization: A Case Report

“…While a relatively new field, robotic-assisted surgeries have been reported across the neurosurgical spectrum, including minimally invasive spine surgery [24], deep brain stimulation [25]), and laser tumor ablation [26]. In the field of epilepsy, however, there is only one report of a robotic-assisted laser ablation of a periventricular EZ in an adult patient [27] and a small series describing use of a robotic system for S-EEG placement in pediatric patients [12]. This latter report also describes a robotic-assisted laser ablation of the posterior corpus callosum for epilepsy in one patient.…”

“…Robotic-assisted (ROSA, Medtech Surgical, Inc.) stereotactic laser ablation of EZ is an emerging minimally invasive technique for the treatment of eloquent EZ in both adult and pediatric populations [12]. In this report, we describe the robotic-assisted S-EEG localization and laser ablation of a nonlesional cingulate gyrus EZ in a pediatric patient.…”

CT-guided Stereotactic Microsurgical Resection of Cerebral Mass Lesions

“…Meanwhile, Leksell established the basis of a novel system combining the cartesian system with other systems, which consisted of an apparatus fixed to Guiot et al 6,7 and Riechert and Mundinger 8 were the first investigators to introduce open stereotactic craniotomy, which was then enjoyed broader applications and further refinements owing to the advances in the field of medical imaging such as computerized tomography 9 and magnetic resonance imaging 10 . Current image-guided stereotactic procedures include biopsy [11][12][13][14][15] , cyst aspiration 16,17 , focal irradiation 18,19 , and hematoma evacuation [20][21][22] , neuroaugmentation 22,23 , stereotactic robotic microsurgery [24][25][26] and neural transplantation 27,28 . These techniques facilitate precise localization and resection of lesions in eloquent regions of brain and help minimize operative injury to the surrounding tissues.…”