There is a new surgical robot in town. ROSA, a Robotized Surgical Assistant, has joined the Houston VA team and is helping doctors detect sources of seizures in patients with epilepsy.
This week surgeons at the Michael E. DeBakey VA Medical Center successfully completed the VA’s first use of the minimally invasive robotic device on an Army Veteran from Oklahoma. ROSA will offer Veterans and their physicians a number of advantages over traditional surgical approaches as they work to improve the quality of life for Veterans.
“With the assistance of ROSA, we only need to make small precise incisions in the scalp and skull to place electrodes deep in the brain and investigate where seizures are triggered, said Dr. Alfonso Fuentes, Chief of Neurosurgery. “The robot improves accuracy, safety, and can significantly reduce total surgery time for our Veterans.”
In order to perform the minimally invasive operation, VA surgeons program coordinates into ROSA’s software, and the arm helps guide the placement of electrodes at exact points in the Veteran’s brain where the abnormal electric signals originate. Once pinpointed, those areas can be targeted for treatment to stop or reduce seizure activity. ROSA’s robotic arm replicates the movements of a human arm, providing a high level of dexterity in performing complex surgical procedures. The surgeon is able to use ROSA without changing any of his or her techniques.
“This new technology will make more data available to the epilepsy team to offer Veterans more advanced treatment options and help them to achieve their dreams to be seizure free,” Fuentes said.
Dr. Sameer Sheth, who performed the surgery, notes that most people with epilepsy are treated effectively with medication, but those whose seizures don’t respond to medication can turn to surgical options.
“Tools like ROSA help us perform brain surgery more safely,” Sheth said. "At Houston VA, we collect quality-of-life data, monitor our outcomes, and stay on top of the latest studies to inform decisions for surgery and what’s best for our Veterans.”
Determining the precise location of the area within the brain that produces abnormal electrical activity and causes seizures is key to successful treatment but can often be very challenging, said Dr. Zulfi Haneef, Houston VA neurologist and an associate professor at Baylor College of Medicine. Once that location is pinpointed, and if it’s not too close to a critical area (for speech or motor centers, for example), it can be surgically removed. The ROSA Robot can also be used for other intracranial surgeries such as implantation of Deep Brain Stimulators for Parkinson’s Disease, Tremors, and Dystonias that are refractory to medical treatment.
From a patient standpoint, the new technology causes much less discomfort, Haneef said. “There is less pain, less discomfort, and patients are much more comfortable in the seizure monitoring unit with the stereo EEG electrodes in place.”
The Epilepsy Center of Excellence at the Houston VA specializes in the evaluation of patients with poorly controlled epilepsy, pre-surgical evaluation of epilepsy patients, consultation on treatment of difficult to control epilepsy patients, and the evaluation of patients with paroxysmal non-epileptic events.
"We are committed to adopting ROSA and other cutting edge technologies that are at the forefront of surgical treatments for epilepsy, movement disorders and intracranial tumors," said Dr. Pitchaiah Mandava, Chief of Neurology at the Houston VA and professor at Baylor College of Medicine. “Veterans deserve the best technology and care we can provide and we’re proud to give it to them.”