Health Care and Technology

Spectrum offers surgical option for epilepsy patients

ROSA, a $400K robotic arm, helps place electrodes or fine instruments precisely within the brain.

September 4, 2015
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Dr. Sanjay Patra, a neurosurgeon with Spectrum Health Medical Group, uses the robotic arm known as ROSA during surgery. Courtesy Spectrum Health

Neurosurgeons at Spectrum Health are accessing the deepest areas of the brain through the use of an innovative robotic arm.

Spectrum Health announced Aug. 20 it is among the first in the nation to provide an advanced option for neurosurgery through the acquisition of a more than $400,000 surgeon-directed robotic arm known as ROSA.

The robotic technology assists neurosurgeons in planning the trajectory of how to navigate the brain, and also in placing fine instruments such as electrodes for patients with epilepsy or for deep brain stimulation for patients with Parkinson’s disease.

Neurosurgeon Kost Elisevich, co-chair of the department of clinical neurosciences and chief of neurosurgery at Spectrum Health Medical Group, said ROSA is essentially a delivery tool with planning software that allows for electrode introduction and for the procedure to be conducted without necessarily using a frame attached to the patient’s head.

“It started out as a precision delivery system that allows one to introduce electrodes or fine instruments within the depths of the brain to any location, and the glory of it is that you can plan out the trajectory in a way that minimizes the harm to the patient,” said Elisevich.

Spectrum Health acquired a ROSA robotic arm from Medtech, a French surgical technology firm, earlier this year. The device is valued between $400,000 and $500,000. Spectrum conducted its first case in April.

The health system entered into discussions about acquiring the equipment after Elisevich visited Montreal a couple of years ago and watched a procedure using ROSA.

“I had heard about ROSA beforehand because of its use in Europe, and it was primarily being used for the implant of electrodes in an attempt to investigate patients with epilepsy to try to figure out where it arose within the brain,” said Elisevich.

“There was a need for precision delivery of electrodes in various locations in the brain. I stopped by the old institute and watched my training mentor use the ROSA for a tumor case associated with epilepsy.”

Dr. Sanjay Patra, a neurosurgeon with Spectrum Health Medical Group, said robotic technology is at the forefront of the next generation of surgical treatments for epilepsy.

“With these new technologies, we are accessing the deepest areas of the brain and expanding treatment of neurological disorders,” said Patra.

The ROSA was designed to increase the safety and reliability of neurological procedures and can improve accuracy and reduce the length of hospital stay for patients, according to a press release.

Medtech indicated the device’s advantages include increased patient comfort due to no longer needing to use a stereotactic frame, reduced operating room time up to 50 percent depending on the procedure, and a combined patented registration technology with an ultra-precise laser sensor.

“Oftentimes, if you insert something into the brain through a very limited approach, you stand the chance of harming the patient if you run across a blood vessel, or injury through an aspect of the brain that is a little more eloquent in terms of what it does for you on a daily basis, whether it is speech, motor, sensory or visual functions,” said Elisevich.

Other applications include implanting electrodes on a permanent basis for some epileptic patients, planning trajectories to deep-seeded tumors, and pairing it with the Visualase system to deliver laser energy to a site within the brain to destroy the abnormal tissue with little impact on the surrounding area.

By bringing the innovative technology to West Michigan, Elisevich said patients with complex forms of epilepsy can remain here rather than having to travel to other health systems, such as Henry Ford, University of Michigan, Cleveland Clinic or Mayo Clinic.

“We have a very intensive epilepsy surgery program at Spectrum. There is no reason why they should be travelling the distance they are if we can have this sort of facility here that is set up in exactly the same way,” said Elisevich.

“Of course, the importance of the program rests in the people that are acquired so we have taken care to bring on epileptologists or neurologists who are skilled in epilepsy work into our fold.”

Elisevich indicated the team at Spectrum focusing on patients with epilepsy includes eight epileptologists, a neuropsychology group and two neurosurgeons within the neurosurgery group who have a strong interest in epilepsy.

“The purpose here was to not just gather up the people who are skilled in the discipline, but also to acquire the technical assets necessary to conduct this sort of investigation and the treatment that is necessary to deal effectively with any and every patient who presents here with any form of epilepsy,” said Elisevich.

“We need to have the equipment aligned with the right minds to make this happen.”

With roughly 0.5 to 1 percent of the population in the United States afflicted with epilepsy, Elisevich said the number of people who are living with the condition can be translated to roughly 100,000 people in the state of Michigan, assuming a population of 10 million.

“There are a substantial number who are medically intractable — who can’t be helped by medication — because they continue to have breakthrough seizures,” said Elisevich. “There needs to be a way of fixing these patients as best as possible.”

The Centers for Disease Control and Prevention indicates roughly 1 percent of adults at least 18-years-old have active epilepsy, which is about 2.4 million individuals based on the population in 2013.

Indirect and direct costs of epilepsy in the United States are estimated to be up to $15.5 billion each year, according to the CDC.

“The ROSA in and of itself is a very nice piece of equipment, certainly, and we know of its benefits from the experiences that have been gained in Montreal and, in particular, in Europe — in France,” said Elisevich.

“It is just part of a much larger enterprise. It is not just a piece of machinery that is used; there is a very real purpose to it.”

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