Neurosurgery Team Utilizes ROSA ONE Brain to Perform First Deep Brain Stimulation Implant at Arkansas Children’s

Arkansas Children’s Hospital (ACH) neurosurgeons performed close to 30 surgeries with Robotic Operating Surgical Assistant (ROSA) ONE Brain, a surgical robot allowing for precise placement of electrodes into the brain, since December 2021. On Jan. 23, 2023, the team placed the first deep brain stimulation (DBS) implant with ROSA.

Arkansas Children's neurology and neurosurgery experts are nationally renowned, providing the highest level of care utilizing leading therapies and updated approaches to disease management. Arkansas Children's Comprehensive Epilepsy Program is a Level 4 Epilepsy Center accredited by the National Association of Epilepsy Centers. Our epileptologists have the professional expertise, facilities and technology to provide unmatched medical and surgical evaluation and treatment for patients with complex epilepsy.

ROSA and similar technologies are being used more frequently throughout the United States and worldwide, making ACH part of an innovative trend.

Picking the Right Patient

ROSA is often used at ACH for stereoelectroencephalography (SEEG), to locate where seizures come from in the brain so medical experts can recommend the best surgical treatment for a patient's epilepsy. ACH neurosurgeons also use it for DBS, responsive neurostimulation (RNS) and soon for the placement of lateral ablation fibers to treat epilepsy and tumors.

Gregory W. Albert, M.D., M.P.H., FAANS, FACS, FAAP, chief of pediatric neurosurgery at ACH, Lee and Bob Cress endowed chair in pediatric neurosurgery and professor of neurosurgery at the University of Arkansas for Medical Sciences (UAMS), used ROSA to perform the first DBS implant on a then 14-year-old patient with drug-resistant epilepsy. Viktoras Palys, a neurosurgeon from UAMS, also assisted with the operation.

"The DBS simulates a specifically targeted area of the thalamus for the treatment of seizures," Albert said. "In this case, we placed the electrodes into the anterior nucleus of the thalamus bilaterally. Stimulating this area has been shown to have good effect for the treatment of specific types of epilepsy."

Virginia Erin Willis, M.D., chief of neurology at ACH and associate professor of pediatrics in the division of pediatric neurology at UAMS, served as the patient’s epileptologist. She explained the pediatric patient was prescribed multiple anti-seizure drugs but continued to have frequent seizures.

"He underwent phase one epilepsy surgery evaluation to help determine the best treatment for his epilepsy. This showed that he had an increased risk for seizures from multiple areas of his brain," Willis said. "Given this, the surgical epilepsy team felt he was not a good candidate for a resective surgery but would benefit from placement of a DBS to help improve seizure control."

Continued Success

The patient was in the operating room for nearly five hours, including the hour and 45 minutes to set up anesthesia, ROSA, prepping and draping. In addition to surgeons Albert and Palys, the team included neurosurgery resident Will Coggins, anesthesiologists, nurses and a scrub tech. Representatives from DBS-makers Medtronic and ROSA-makers Zimmer-Biomet were also in the OR.

Willis said the patient has already seen a decrease in seizures since implantation and has tolerated it without side effects.

"ROSA provides an accurate, efficient and, importantly, safe way to place electrodes into the brains of patients. This allows us to offer effective, minimally invasive and novel diagnostic and therapeutic surgeries for epilepsy," Albert said. "DBS is very effective for epilepsy and well-tolerated by patients. As technology advances, we will be able to offer these, and perhaps other surgeries, for patients with epilepsy that do not respond to medication."