ROSA™, a robotic platform, quickly, safely and precisely helps identify brain abnormalities that trigger epilepsy in children.
Santiago, age 5, has a rare disease called tuberous sclerosis. The genetic disorder causes dozens and dozens of noncancerous tubers (hard benign masses) to develop in many parts of his body, including his brain and other vital organs: kidneys, heart, eyes, and lungs. In his brain alone, there are 40-50 tubers of various sizes. Two tubers are causing his two different types of epileptic seizures. But, which two? ROSA™ will help figure that out.
ROSA™ is the newest member of the neurosurgery team at The Montreal Children’s Hospital (The Children’s). Residing in the Pediatric Interventional Brain Suite, ROSA™ is the first robotic medical assistant in a Quebec pediatric hospital. ROSA™ offers a safer and less invasive surgery for epilepsy known as stereotactic implantation of electrodes. The robot optimizes the insertion of electrodes into the brain through tiny drill holes. The electrodes monitor for abnormal brain activity. And in Santiago’s case, pinpoint exactly which tubers are causing his seizures so they can be removed.
ROSA™ a game-changer
To prepare for this minimally invasive surgery, Dr. Kenneth Myers, Santiago’s neurologist and epileptologist, first orders a variety of tests to help narrow down the offending tumour(s). Tests include, among others:
an MRI scan (magnetic resonance imaging), to identify the location of the 40-50 tubers,
a brain wave test, also called an EEG (electroencephalogram), to look for changes in the brain's electrical patterns that are related to seizures
Thanks to ROSA™, surgeons can detect the part(s) of the brain causing the seizures much more quickly and precisely.
Armed with these test results, neurosurgeon, Dr. Roy Dudley prepared for Santiago’s stereotactic procedure. The first step, he used ROSA’s™ computer to design safe trajectories for each of 17 tiny electrodes (0.8 mm diameter) to pass through the little boy’s brain -- avoiding all blood vessels, and coming to rest in and around the various tubers. Then on the day of the procedure, Dr. Dudley operated ROSA’s™ robotic arm to move to each preprogrammed entry point in Santiago’s skull; the robot holds its rigid arm perfectly steady allowing the physician to drill tiny holes at the precise points. The robot removes the millimetric human error that would occur without stereotactic-robotic guidance.
Steady now!
Through the drill holes, Dr. Dudley then slides the electrodes deep into Santiago’s brain, without causing problems for all vital brain structures that control such things as vision, language and movement.
The innovative procedure didn’t require cutting the child’s hair, cutting open his scalp, or removing a piece of his skull. Thanks to ROSA™ the time to implant the electrodes is reduced from 6 hours to 2 hours.
With ROSA™ on the team, children like Santiago endure much less physical trauma such as pain, swelling, bleeding, cerebrospinal fluid leak, and infections. The risk of complication is extremely low, and when the electrodes are removed, the patient can go home the next morning.
Within hours of the procedure, the neurology team was able to identify exactly which two tubers were causing Santiago’s epileptic seizures. One tuber located on the right side of his brain was causing 2-3 visible seizures per week while another tuber on the left side of his brain was causing almost 100 imperceptible seizures per day. Even imperceptible seizures are problematic because they severely impair brain development.
Now for the brain surgery
Armed with the precise location of the offending tubers, neurosurgeon, Dr. Jean-Pierre Farmer performed two surgeries. It would simply be too long and too traumatic for the patient to be operated on both the right and left hemispheres of the brain in one operation. The first surgery took place a couple of weeks after the stereotactic procedure. Then after a recovery period of seven weeks, Santiago underwent the second surgery to remove the tuber causing the visible epileptic seizures.
Santiago went home five days after his second surgery. His parents noticed an advance in his development after the first surgery, and they have not yet witnessed any more seizures. His condition will continue to be monitored by Dr. Myers, Dr. Farmer, and other specialists at The Children’s.
A fairy tale ending is uncertain
We hope Santiago’s story has a ‘happy ever after ending’, but the future is difficult to predict for children with tuberous sclerosis. In a few years, it is possible another tuber in the brain might start acting up triggering epilepsy all over again. As well, the other masses scattered throughout his body might prompt other medical issues such as kidney or heart problems or vision issues. Whatever the future holds, the experts at The Children’s will be there for Santiago and his family.
The Montreal Children’s Hospital Foundation and the neurology and neurosurgery teams offer a huge thank you to its dedicated partner, Opération Enfant Soleil, who donated $1-million to fund the purchase of ROSA™.