Epilepsy care gets a robotic boost at UC San Diego Health

Neurosurgery is one of the most difficult branches of surgery. The human brain, with its approximately 100 billion neurons and 100 trillion connections, is arguably the most complex biological structure known, and surgeons often must operate within the narrow confines of the brain, spinal cord and nervous system. .

Sometimes it’s good to have another pair of “hands”, a ROSA by another name.

Sage Magaña, 18, recently underwent a new minimally invasive intracranial monitoring procedure to help identify the source of the epileptic seizures that she says ended her life. With the help of a new robot named ROSA, thin electrodes were inserted into his brain to monitor his electrical activity.

ROSA is short for Robotic Stereotactic Assistance, and at UC San Diego Health’s Department of Neurosurgery, cutting-edge technology is at your fingertips.

Of the many procedures in which ROSA can help, it perhaps shines brightest during stereotaxic electroencephalography (sEEG), an intracranial monitoring procedure in which 10 to 20 thin electrodes (less than 1 millimeter in diameter, approximately the thickness of a credit card) are inserted into the brain to precisely map the locations from which epileptic seizures emanate.

Sharona Ben-Haim, MD, a UC San Diego Health neurosurgeon who introduced sEEG to the San Diego area five years ago, calls the procedure “much faster and safer now, and with the efficiency and the precision that only a robotic platform can provide”.

Sage Magaña, 18, recently underwent the ROSA-assisted procedure. Two years ago, he was diagnosed with frontal lobe epilepsy, with a typical day interrupted by up to five seizures lasting up to five minutes each. It sometimes took weeks to fully recover from the most severe episodes.

“I wake up from a seizure and I’m limping, crying, it’s horrible,” said Sage, who lives with her parents in Vista. “I have a headache, jaw, tongue and cheek pain from biting them. It took everything from me. It stopped my entire life.

Because of his seizures, Sage dropped out of high school after his sophomore year. Driving is a distant memory. This is not the typical life of a teenager.

Robot ROSA Ben-Haim and Khalessi

Sharona Ben-Haim, MD, neurosurgeon at UC San Diego Health poses with Alexander Khalessi, MD, chair of the department of neurosurgery at UC San Diego Health, and their new robotic assistant.

Only a very specific type of patient is likely to receive an sEEG, someone for whom brain surgery has become a last resort due to drug-resistant epilepsy. Sage said the anti-epileptic drugs she tried ‘worked a little, but not enough’ and most produced unwanted side effects, such as making her feel ‘crazy’ and ‘angry when I’m not. “.

Sage opted for surgery on the recommendation of Ben-Haim and Jerry Shih, MD, director of the epilepsy center at UC San Diego Neurological Institute, following a multidisciplinary conference on his case.

Based on Sage’s MRI, Ben-Haim programmed into ROSA where each electrode should be inserted, after which ROSA’s robotic arm rotated to the precise positions for each insertion.

“Each of the electrodes is planned with great precision to enter and terminate (terminate) in a certain part of the brain, and to map specific anatomical features along its path,” said Ben-Haim, the only neurosurgeon at the San Diego County. ROSA-assisted sEEG in adults. (Rady Children’s Hospital-San Diego has a ROSA for pediatric cases.)

ROSA patient robot

Wires from the implanted electrodes record electrical activity inside Sage’s brain, giving him the unique experience of seeing the onset of his seizures via spikes in the reading.

“The location of the electrodes is very specific to each patient, based on a very thorough preoperative assessment that we carry out.” (Before the advent of sEEG, neurosurgeons placed grid, strip, and depth electrodes for intracranial monitoring. These were often very complicated procedures.)

When she came out of anesthesia after the sEEG procedure at Jacobs Medical Center at UC San Diego Health, Sage said she “felt a little pain, but it was very bearable — especially knowing that it was my chance to get my life back.”

The electrodes stayed in Sage’s brain for a week, mapping his seizures. The data obtained (still being analyzed) will make it possible to determine the best treatment. This may include laser-assisted ablation or resection of the region of the brain causing the seizures.

“I just want to stop the seizures,” Sage said, so she can pursue a normal life and maybe a career helping others through their epilepsy journeys.

“I want to be that person for someone else,” she said.

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