Robotic thermocoagulative hemispherotomy: concept, feasibility, outcomes, and safety of a new "bloodless" technique.

Autor:	Chandra PS; Departments of1Neurosurgery.; 6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India., Doddamani R; Departments of1Neurosurgery.; 6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India., Girishan S; Departments of1Neurosurgery., Samala R; Departments of1Neurosurgery., Agrawal M; Departments of1Neurosurgery., Garg A; 2Neuroradiology., Ramanujam B; 4Neurology, and., Tripathi M; 3Nuclear Medicine., Bal C; 3Nuclear Medicine., Nehra A; 5Clinical Psychology, and., Tripathi M; 4Neurology, and.; 6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2021 Apr 02; Vol. 27 (6), pp. 688-699. Date of Electronic Publication: 2021 Apr 02 (Print Publication: 2021).
DOI:	10.3171/2020.10.PEDS20673
Abstrakt:	Objective: The authors present a new "bloodless" technique for minimally invasive robotic thermocoagulative hemispherotomy (ROTCH). Such a method is being described in the literature for the first time. Methods: A robotic system was used to plan five sets of different trajectories: anterior disconnection, middle disconnection, posterior disconnection, corpus callosotomy, and temporal stem and amygdalar disconnection. A special technique, called the "X" technique, allowed planar disconnection. Registration was performed with surface landmarks (n = 5) and bone fiducials (n = 1). Coregistration with O-arm images was performed one or two times to confirm the trajectories (once for middle disconnection, and once for disconnection of the temporal stem and amygdala or body of the corpus callosum). Impedance measured before ablation allowed for minor adjustments. Radiofrequency ablation was performed at 75°C-80°C for 60 seconds. Surgical procedures were performed with multiple twist drills. After removal of the electrode, glue was used to prevent CSF leak, and a single stitch was applied. Follow-up CT and MRI were immediately performed. Results: The pathologies included Rasmussen's encephalitis (n = 2), hemispheric cortical dysplasia (n = 2), posttraumatic encephalomalacia (n = 1), and perinatal insult (n = 1). The mean ± SD (range) age was 6.7 ± 3.6 years (5 months to 10.2 years), and the right side was affected in 4 patients. The mean ± SD seizure frequency was 7.4 ± 5.6 seizures per day (1 patient had epilepsia partialis continua). The mean ± SD number of trajectories was 15.3 ± 2.5, and the mean ± SD number of lesions was 108 ± 25.8. The mean ± SD maximum numbers of trajectories and lesions required for middle disconnection were 7.1 ± 1.7 and 57.5 ± 18.4, respectively. All but 1 patient had class 1 outcomes according to the International League Against Epilepsy Outcome Scale at a mean ± SD (range) follow-up of 13.5 ± 1.6 (12-16) months; the remaining patient had a class 2 outcome. The estimated blood loss was < 5 ml for all patients. Complications included repeat surgery (after 2 weeks) for a "skip" area (n = 1) and a small temporal hematoma (n = 1), which resolved. Conclusions: ROTCH seems to be a safe, feasible, and bloodless procedure, with a very low morbidity rate and promising outcomes.
Databáze:	MEDLINE
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