Advanced Procedures

Our neurosurgical team performs a wide range of minimally invasive procedures, which result in less blood loss and, frequently, a faster recovery time. These procedures include laser surgery for epilespy, robotic surgery, bloodless surgery, endoscopic craniotomy for craniofacial disorders, keyhole craniotomy and concurrent endoscopy. Computer-assisted imaging is used to make the procedures as safe and effective as possible.

Laser Surgery for Epilepsy

Rady Children’s is among a select group of children’s hospitals offering cutting-edge laser surgery for epilepsy, made possible with Visualase laser ablation technology.

The procedure involves the use of a laser catheter carefully inserted into the brain through a small hole in the skull. A robotic device called ROSA (see below) assists the surgeon’s placement of the laser catheter for exact accuracy. The patient is then taken to the MRI suite where the laser ablation occurs. Laser energy is delivered to the tissue using a laser applicator, and as light is delivered through the applicator, temperatures begin to rise and destroy the harmful tissue. The MRI allows the surgeon to see what’s happening in real-time, so he can precisely monitor the treatment and protect the surrounding healthy tissue.

Advantages of this minimally invasive procedure include a faster operation time, minimal sutures (typically one stitch), quicker recovery time and reduced scarring.

Minimally Invasive Robotic Surgery

Rady Children’s is among a select group of children’s hospitals with ROSA, a highly advanced surgical robot assistant. ROSA can be used in epilepsy surgery and other neurosurgical procedures, ranging from tumor biopsies to deep brain stimulation for movement disorders.

ROSA has two main parts: a computer “brain” for 3-D imaging and stereotactic planning, and a robotic arm that directs surgical instruments with extreme accuracy.

For epilepsy surgery, ROSA helps the surgeon to place a series of very fine electrodes deep within the brain to detect where seizures are coming from. The electrodes are placed in a safe, exact and minimally invasive fashion, which not only improves the precision of the procedure, but speeds the recovery of our young patients. ROSA can also be used in combination with laser technologies, enabling epilepsy and certain tumors to be cured without the need for an invasive craniotomy. Watch the video below.

Video: Minimally invasive epilepsy surgery using ROSA

Bloodless Surgery

Our protocol for bloodless surgery allowed for the first bloodless hemispherectomy in the western United States to be performed at Rady Children’s. This protocol includes the preoperative administration of epoetin to maximize the hematocrit, along with the use of isovolemic or hypervolemic hemodilution, to lower patients’ hematocrit intraoperatively.

Endoscopic Craniotomy for Craniofacial Anomalies

Rady Children’s craniofacial team uses minimally invasive endoscopic techniques for the treatment of craniofacial disorders. These advanced techniques produce optimal cosmetic results (by allowing for small incisions) and reduce surgery time and blood loss. Our program is one of the largest referral centers for endoscopic craniofacial procedures in the United States.

Keyhole Craniotomy and Concurrent Endoscopy

To minimize surgical trauma to children, our team uses novel techniques, such as the “keyhole approach” for arachnoid cysts, and “supraorbital keyhole approaches” for suprasellar tumors or interhemispheric conditions. These techniques depend significantly on the use of modern technologies, such as concurrent three-dimensional endoscopy, which allows for the simultaneous use of the operating microscope and the endoscope. Concurrent techniques allow for multiple views of the anatomy despite a smaller operative corridor.

Neurosurgical Integration of Computer-Based Technologies

Computer-based anatomic renderings are commonly used by radiologists and surgeons but have not been fully integrated into standard operating practice. Currently, the Neurosurgery Division uses two modalities for incorporation of the images into the operating room, allowing for the use of peri-operative and intra-operative imaging. Image-based workstations provide for three-dimensional reconstructions directly from computed tomography (CT) or magnetic resonance imaging (MRI) data.

To maximize the amount of anatomic information available to the surgeon during the procedure, the images can be displayed via a 3-D HMD system or picture-in-picture modification that Rady Children’s has integrated into the surgeon’s optics of the operating microscope. The modifications allow the surgeon to operate under the microscope with the benefit of an endoscopic view absent the real-time use of an endoscope.