Medtech earned FDA approval for its robotic stereotactic assistance device – ROSA® Brain – in 2018. Now, ROSA® Brain is beginning to arrive in surgical suites nationwide. The new technology offers a minimally invasive approach to precision brain mapping and can guide instrument placement for a variety of neurosurgeries.
The first ROSA® Brain-guided procedure in Tennessee was performed by Robert Naftel, M.D., pediatric neurosurgeon at Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt. While Naftel and his colleagues used to perform their stereoelectroencephalography (SEEG) at the adult hospital, Children’s Hospital now has its own ROSA® Brain.
“Transporting the children and pulling nursing and other resources from Children’s Hospital was not sustainable,” Naftel said. “Now that we can use our own staff and facility, we have performed more procedures in a shorter time frame than ever before.”
How It Works
“It acts as a system for us to make surgical plans accurate, precise and safe.”
ROSA® Brain supports stereotactic operations by eliminating the need for frames or external, fixed landmarks. Instead, a robotic arm moves along six axes, guided by pre-operative reference images.
The manufacturer calls it “a kind of ‘GPS’ for the skull” that can assist surgical planning and “key-hole” interventions. The robotic arm’s dexterity helps neurosurgeons implant electrodes and perform other procedures with unprecedented precision. It also provides real-time haptic feedback to keep surgeons away from surrounding tissues.
Neurosurgeons can use ROSA® Brain to inform SEEG and place electrodes into areas of the brain where seizures appear to originate. “It acts as a system for us to make surgical plans accurate, precise and safe,” Naftel said.
Guiding Seizure Diagnostics
“The most common application for ROSA® Brain has been in treating medically refractory epilepsy,” Naftel said. “When children are no longer responding to epilepsy medications, we consider surgical options by determining where in the brain the seizures originate.”
Scalp EEGs and MRIs can sometimes locate seizure sources, but typically more invasive diagnostics are needed. Naftel’s team may use data from combinations of video EEG, MRI, PET, SPECT, MEG, physical exams and neuropsychological testing to form hypotheses about where the seizures are coming from. They then import a patient’s MRI into the ROSA® Brain software and together, with information from these other sources, develop a personalized plan for electrode placement.
“On the day of the surgery, plans are already loaded into the robot.”
“All this planning work occurs ahead of the surgery such that on the day of the surgery, plans are already loaded into the robot and it’s just a matter of registering the robot to the child’s anatomy and inserting the electrodes,” Naftel said.
Greater Precision, Shorter Procedure
ROSA® Brain can guide surgeons through electrode entry, trajectory and termination. “It provides submillimeter accuracy and stability we would not have with the frames or other devices we used to use,” Naftel said. Once the seizure locations are confirmed by electrode, neurosurgeons may remove or ablate the tissues where they originate.
With ROSA® Brain, Naftel’s surgeries have shortened from four to five hours down to about three, so children are under anesthesia for a shorter time. Improved precision during electrode placement also helps avoid contact with critical brain structures and blood vessels.
Versatility is part of ROSA® Brain’s appeal. Said Naftel, “It’s different than other robotic surgery, like da Vinci® systems, where a robot has instruments to perform procedures. With ROSA® Brain, it’s all about lining up trajectories and acting as a platform for us to perform procedures.”
Neurosurgeons are also using ROSA® Brain in guided biopsy, shunt placement and deep brain stimulation. “The robot can also be used to guide laser treatments, and all this is done minimally invasively,” Naftel said. “We’re never drilling a hole in the skull more than a few millimeters wide.”