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

J Neurosurg Pediatr. 2017 Oct;20(4):364-370. doi: 10.3171/2017.5.PEDS1782. Epub 2017 Aug 4.


OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Keywords: EEG = electroencephalography; ETV = endoscopic third ventriculostomy; LITT = laser interstitial thermotherapy; depth electrodes; epilepsy; laser ablation; robotic neurosurgery; stereo-EEG; surgical technique.

MeSH terms

  • Adolescent
  • Biopsy
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / surgery*
  • Child
  • Child, Preschool
  • Electroencephalography
  • Epilepsy / diagnostic imaging
  • Epilepsy / surgery*
  • Female
  • Follow-Up Studies
  • Glioma / diagnostic imaging
  • Glioma / surgery*
  • Humans
  • Imaging, Three-Dimensional
  • Laser Therapy / methods
  • Magnetic Resonance Imaging
  • Male
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Stereotaxic Techniques
  • Tomography Scanners, X-Ray Computed
  • Young Adult