Head shaved, a little boy rests on the operating table, deep under anesthesia. His parents have brought him to Boston Children’s Hospital in hopes of determining the cause of his seizures. Now, neurosurgeons Scellig Stone, MD, PhD, Joseph Madsen, MD, and their colleagues in the Epilepsy Center are performing a procedure designed to monitor seizure activity in the 3-year-old’s brain.
But as the team members crowd around the table, they’re not alone. With the push of a button, a large robotic arm rotates and lowers right next to the boy’s head, helping the physicians pinpoint the precise location to drill. “This is a real game-changer,” murmurs one of the clinicians observing the surgery. “It’s going to transform the way we practice.” …
A 4-year-old has a progressively enlarging head and loss of developmental milestones: a clear case of hydrocephalus. He undergoes a minimally invasive endoscopic third ventriculostomy (ETV) to drain off the trapped cerebrospinal fluid.
This requires puncturing the floor of the brain’s third ventricle (fluid-filled cavity) with an endoscope — while avoiding a lethal tear in the basilar artery, which lies perilously close.
There are no good neurosurgical training models for this rare and scary operation.
“We semi-blindly poke a hole through the ventricle floor,” says Benjamin Warf, MD, director of Neonatal and Congenital Anomaly Neurosurgery at Boston Children’s Hospital. “To make the technique safer and to be able to train more people, it would be very helpful to make that hole in a way that’s less anxiety-provoking.” …
When epilepsy can’t be controlled with drugs, neurosurgery is sometimes curative, if the seizures are coming from discrete brain tissue that can be safely removed.
Finding these diseased areas, however, can require invasive surgery to place grids of electrodes on the brain’s surface. That’s followed by long-term, 24-hour EEG monitoring — typically for a week — until a seizure happens. Neurosurgeons then use this data to map a surgical path. But to actually remove the diseased tissue, a second operation is needed.
That’s enough to deter many families from epilepsy surgery. But what if seizure origins could be mapped without having to actually observe a seizure?
Joseph Madsen, MD, director of Epilepsy Surgery at Boston Children’s Hospital, and Eun-Hyoung Park, PhD, a computational biophysicist in the Department of Neurosurgery, think they have a way to do that — with an algorithm originally used for economic forecasting. …