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Robotic Neurosurgery for Brain

Dr. R. Chandrasekhar Naidu, Wednesday, January 27, 2021

Robotic Neurosurgery for Brain

Rare Milestone Achieved by KIMS Hospitals, Neurosciences Department.
• 8 electrodes placed in the brain of a 9-year-old boy to detect seizures centre
• In India, only 3-4 cities have robotic neurosurgery in their practice


For the first time in Telangana & AP, Robotic neurosurgery was used to detect seizures centre in a 9-year-old boy's brain by Neurosurgery team at KIMS Hospitals. It’s a latest advancement in Neurosurgery practice. A robot with image guidance helps in achieving precision and faster neurosurgery. Robot-guided neurosurgery is available in a few cities worldwide. In India, only 3-4 cities have robotic neurosurgery in their practice.
The robotic system helps in various brain surgeries including Epilepsy surgery, Stereotactic guided brain tumour biopsy, Parkinson's disease (deep brain stimulation), Brain tumor surgery to identify important and problematic parts of the brain. With the help of a robotic system, neurosurgeons can operate brain tumour with small opening in skull which helps in early recovery and less pain to the patients.
A 9-year-old boy was brought to KIMS Hospitals with uncontrolled seizures in spite of multiple medications. The patient was suffering from almost five years. He used to get 6-7 seizures every day. Because of this, he was unable to attend the school. Rest of the body development is normal.  He was initially evaluated with MRI brain and video EEG by Neurology team at KIMS Hospitals.  However the exact locations from where the seizure were starting was not getting captured. For such patients, electrodes have to be kept in the brain to find out seizure onset.  In this, patient robotic guided eight electrode placements were done in the brain successfully by KIMS Neurosurgery team to record brain electrical activity which helps in identification of the place from where seizures are coming and further details. This type of surgery is technically quite demanding. The exact location of the electrode is of prime importance. This new robotic system helps in the most precise placement of EEG electrodes.  In India, such treatment is available in a few centres. KIMS hospitals is one of the leading institutes in epilepsy treatment in India. And using the robotic system helps in better outcomes for epilepsy patients.
Previously, this procedure used to take 7 hours. Firstly, a frame needs to be placed in the head under local anaesthesia and then CT scan and MRI must be done which was little painful procedure. Then after, anaesthesia will be given and another frame will be placed for calculation. After this, the surgery used to be undertaken. But in the revised procedure, anaesthesia is  given at the start. The patient will not feel any pain in this new. With the use of robotic system, there is 50 % reduction in the duration of surgery. Cost wise too, the new procedure costs same as previous one. With conventional frames, there was a limitation of the number of electrodes which are placed (6-7 only). But now, any number of electrodes as per the requirement can be placed in the head. With these electrodes, the area where these seizures are originating can be perfectly determined by recording of electrical activity of brain by epileptologist. Once this is determined, whether this part can be removed or not will be decided by the doctors. In this boy epilepsy team have localized from where the seizure is starting and planning for resection surgery in future.  Post final surgery, the boy may be allowed to attend the school and continue his day-to-day activities.
The pros of this new procedure are, it is painless and it is more precise than former procedure because of less manual intervention. The time taken for the robotic procedure is also very less. This is robotic guided calculation unlike the previous procedure which is manually done by surgeons. Because of the use of robots, the biopsy time will also drop down drastically.

By 
Sr. Consultant Neurosurgery.

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