Advances in Treatment for Complex Epilepsy Cases: The Benefits of Stereoelectroencephalography (SEEG) with Robotic Neurosurgical Assistant (ROSA®)

By Tsulee Chen, MD, and Gwyneth Hughes, MD
Wednesday, June 14, 2017

Epilepsy is a common neurological problem which presents unique challenges in both diagnosis and treatment, particularly for young patients. According to the Epilepsy Foundation, the average incidence of epilepsy in the U.S. is around 150,000 each year. The incidence is higher among young children and older adults. In the past, approaches to treating medically resistant cases of epilepsy both in children and adults often held few options in terms of mapping and identifying the location of seizure foci, which did work for many patients. Yet with advances in mapping procedures, particularly with the aid of robotics, pediatric patients have options to undergo less invasive methods of monitoring.

Estimates from the U.S. Centers for Disease Control and Prevention report there are about 460,000 children aged 0-17 years who have active epilepsy. Of these, 20% do not respond to medical management. In the past, pediatric neurosurgeons have used subdural grid electrode (SDE) implantation on these patients, which was the traditional method for invasive monitoring in the United States. This type of invasive electroencephalography required two operations, one of which included removing pieces of the young patient’s skull and gently inserting electrodes on the brain’s surface to monitor seizures.

SEEG is a surgical procedure used on children with epilepsy to define the seizure foci. It is less invasive than what is required for subdurals. This procedure is catered toward individuals of any age with deep-rooted lesions, a need for bilateral implantations, reoperations, patients with normal MRI with generalized epileptogenicity, or those with insula, cingulate or SMA-suspected etiology.

There are various patient benefits to the SEEG procedure, including:

  • Safe and precise methodology
  • A more complete delineation of the neural network
  • Access to deeper structures
  • Less time under general anesthesia
  • Less discomfort in the postoperative recovery time

ROSA is a robotic stereotactic assistant used in epilepsy surgery which helps to further minimize risk. To explain, ROSA gives pediatric neurosurgeons safe access to areas of a child’s brain that weren’t accessed in previous approaches. More specifically, ROSA aids in the less invasive implantation of small electrodes into the brain to allow in-depth monitoring of electrical activity in children with seizures.

From a surgical standpoint, there are several benefits to using ROSA in these SEEG procedures. It provides pediatric neurosurgeons access to deep targets within the brain, but also requires less presurgical imaging of patients compared to using the Leksell® frame for implantations, and gives pediatric neurosurgeons monitoring accuracy within 2 mm of the patient’s brain. It facilitates electrode implanting more easily in children than adults, since no wire frames are used during the SEEG procedure compared to other invasive procedures in the past. Overall, ROSA helps pediatric neurosurgeons navigate the brain in a 3-dimensional space with better accuracy by reducing the opportunity to make a human error.

Anecdotally, we have observed that patients who were initially reluctant to have epilepsy surgery are now willing to reconsider, because we are able to offer them SEEG procedures instead of SDE implantation.

With that in mind, by acquiring advanced technology such as ROSA to assist in these surgeries, hospital leadership provides patients with a safer surgical experience. In addition to epilepsy surgeries, the robot has been implemented in other surgical procedures to make their process smoother. These include spine instrumentation, tumor-related procedures such as biopsies and endoscopic procedures.

Dr. Tsulee Chen is board-certified in Neurological Surgery. She is the director of Pediatric Neurosurgery at Akron Children’s Hospital in Ohio. Dr. Gwyneth Hughes is a pediatric Neurosurgeon at Akron Children’s Hospital.