Nelson Jonathon H, Brackett Samantha L, Oluigbo Chima O, Reddy Srijaya K
Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA.
Division of Neurosurgery, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA.
Children (Basel). 2020 Aug 7;7(8):94. doi: 10.3390/children7080094.
Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.
机器人辅助神经外科手术因其高度的精确性和微创方法而得到越来越广泛的应用。机器人立体定向辅助(ROSA)在神经外科手术中的应用在儿科人群中鲜有报道。本病例系列的目的是描述在单中心机构接受ROSA神经外科手术的难治性癫痫患儿的临床经验、麻醉和手术管理以及治疗结果。对2016年8月至2018年6月期间接受ROSA植入立体定向脑电图(SEEG)电极治疗难治性癫痫的患者进行回顾性评估。回顾了患者的人口统计学资料、围手术期管理细节、并发症以及切除或消融手术后的初步癫痫发作结果。本研究纳入了19名接受23次ROSA植入SEEG手术的儿童。平均手术时间为148分钟。11名患者随后接受了切除或消融手术,5名患者使用ROSA辅助插入激光探头进行癫痫病灶消融。总共放置了148根SEEG电极,无任何围手术期并发症。ROSA具有微创性,电极放置精度更高,与传统的脑图谱手术方法相比所需时间更少。由于避免了大的开颅手术,这项新兴技术可能会改善难治性癫痫患儿的围手术期结局;然而,还需要进行长期随访研究。
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