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1 2 EPILEP SY IS A common neurological problem which presents unique cha l- lenges in both diagnosis and treatment, particularly for young patients. According to the Epilepsy Foundation, the aver- age incidence of epilepsy in the U.S. is around 150,000 each year. The incidence is higher among young children and older adults. In the past, approaches to treat- ing medically resistant cases of epilepsy both in children and adults often held few options in terms of mapping and identify- ing the location of seizure foci, which did work for many patients. Yet with advances in mapping procedures, particularly with the aid of robotics, pediatric patients have options to undergo less invasive methods of monitoring. Estimates from the U.S. Centers for Disease Control and Prevention report t her e a r e a b out 4 6 0, 0 0 0 c h i ld r en aged 0-17 years who have active epilepsy. Of these, 20% do not respond to medi- cal management. In the past, pediatric neurosurgeons have used subdural grid electrode (SDE) implantation on these patients, which wa s t he traditiona l method for invasive monitoring in the United States. This t y pe of inva sive electroencephalography required two operations, one of which included remov- ing pieces of the young patient's skull and gently inserting electrodes on the brain's surface to monitor seizures. SEEG is a surgica l procedure used on children with epilepsy to define the seizure foci. It is less invasive than what is required for subdurals. This procedure is catered toward individuals of any age with deep-rooted lesions, a need for bilateral implantations, reoperations, patients with normal MRI with generalized epilepto- genicity, or those with insula, cingulate or SMA-suspected etiology. There are various patient benefits to the SEEG procedure, including: + Safe and precise methodology + A more complete delineation of the neural network + Access to deeper structures + Less time under general anesthesia + Less discomfort in the postoperative recovery time ROSA is a robotic stereotactic assistant used in epilepsy surgery which helps to further minimize risk. To explain, ROSA gives pediatric neurosurgeons safe access to areas of a child's brain that weren't accessed in previous approaches. More specifically, ROSA aids in the less inva- sive implantation of sma ll electrodes into the brain to allow in-depth moni- toring of electrical activity in children with seizures. From a surgical standpoint, there are several benefits to using ROSA in these SEEG procedures. It provides pediatric neurosurgeons access to deep targets w it h i n t he bra i n , but a lso requ i res less presurg ica l ima g ing of patients compared to using the Leksell® frame for implantations, and gives pediatric neurosurgeons monitoring accuracy within 2 mm of the patient 's brain. It facilitates electrode implanting more easily in children than adults, since no wire frames are used during the SEEG procedure compared to other invasive procedures in the past. Overall, ROSA helps pediatric neurosurgeons navigate the brain in a 3-dimensional space with better accuracy by reducing the oppor- tunity to make a human error. Anecdota lly, we have observed that patients who were initially reluctant to have epilepsy surgery are now willing to reconsider, because we a re able to o"er them SEEG procedures instead of SDE implantation. Wit h t h at i n m i nd , b y a c qu i r i n g adva nced technolog y such a s ROSA to a ssist in these surgeries, hospita l leadersh ip prov ides patient s w it h a safer surgica l experience. In addition to epilepsy surgeries, the robot has been implemented in other surgica l proce- dures to ma ke their process smoother. These include spine instrumentation, tumor-related procedures such as biop- sies and endoscopic procedures. Dr. Tsulee Chen is board-certified in Neurological Surgery. She is the direc- tor of Pediatric Neurosurgery at Akron Children's Hospital in Ohio. Dr. Gwyneth Hughes is a pediatric Neurosurgeon at Akron Children's Hospital. ■ The Benefits of Stereoelectroencephalography (SEEG) with Robotic Neurosurgical Assistant (ROSA ® ) 1 2S P ECI A L CL INIC A L S EC T ION: NE UR OLO G Y BY TSULEE CHEN, MD, AND GW YNETH HUGHES, MD ADVANCES IN TREATMENT FOR COMPLEX EPILEPSY CASES: