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Original article
peer-reviewed

Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept



Abstract

Introduction

We describe the feasibility of using minimally invasive robotic laser interstitial thermotherapy (LITT) for achieving an anterior two-thirds as well as a complete corpus callosotomy.

Methods

Ten probe trajectories were plotted on normal magentic resonance imaging (MRI) scans using the Brainlab Stereotactic Planning Software (Brainlab, Munich, Germany). The NeuroBlate® System (Monteris Medical, MN, USA) was used to conform the thermal burn to the corpus callosum along the trajectory of the probe. The distance of the ideal entry site from either the coronal suture and the torcula or nasion and the midline was calculated. The distance of the probe tip from the dorsal and ventral limits of the callosotomy in the sagittal plane were also calculated.

Results

Anterior two-thirds callosotomy was possible in all patients using a posterior parieto-occipital paramedian trajectory through the non-dominant lobe. The average entry point was 3.64 cm from the midline, 10.6 cm behind the coronal suture, and 9.2 cm above the torcula. The probe tip was an average of 1.4 cm from the anterior commissure. For a total callosotomy, an additional contralaterally placed frontal probe was used to target the posterior one-third of the corpus callosum. The average entry site was 3.3 cm from the midline and 9.1 cm above the nasion. The average distance of the probe tip from the base of the splenium was 0.94 cm.

Conclusion

The directional thermoablation capability of the NeuroBlate® system allows for targeted lesioning of the corpus callosum, to achieve a two-thirds or complete corpus callosotomy. A laser distance of < 2 cm is sufficient to reach the entire corpus callosum through one trajectory for an anterior two-thirds callosotomy and two trajectories for a complete callosotomy.



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Original article
peer-reviewed

Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept


Author Information

Harminder Singh Corresponding Author

Department of Neurosurgery, Stanford University Medical Center

Walid I. Essayed

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Sayantan Deb

Medical School, Stanford University School of Medicine

Caitlin Hoffman

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Theodore H. Schwartz

Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

Harminder Singh and Walid I. Essayed contributed equally to the manuscript. We thank Matthew Holt for the medical illustrations and Cindy H. Samos for manuscript editing.


Original article
peer-reviewed

Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept


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Original article
peer-reviewed

Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept

  • Author Information
    Harminder Singh Corresponding Author

    Department of Neurosurgery, Stanford University Medical Center

    Walid I. Essayed

    Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

    Sayantan Deb

    Medical School, Stanford University School of Medicine

    Caitlin Hoffman

    Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

    Theodore H. Schwartz

    Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    Harminder Singh and Walid I. Essayed contributed equally to the manuscript. We thank Matthew Holt for the medical illustrations and Cindy H. Samos for manuscript editing.


    Article Information

    Published: February 10, 2017

    DOI

    10.7759/cureus.1021

    Cite this article as:

    Singh H, Essayed W I, Deb S, et al. (February 10, 2017) Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept. Cureus 9(2): e1021. doi:10.7759/cureus.1021

    Publication history

    Received by Cureus: December 13, 2016
    Peer review began: December 28, 2016
    Peer review concluded: January 17, 2017
    Published: February 10, 2017

    Copyright

    © Copyright 2017
    Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

We describe the feasibility of using minimally invasive robotic laser interstitial thermotherapy (LITT) for achieving an anterior two-thirds as well as a complete corpus callosotomy.

Methods

Ten probe trajectories were plotted on normal magentic resonance imaging (MRI) scans using the Brainlab Stereotactic Planning Software (Brainlab, Munich, Germany). The NeuroBlate® System (Monteris Medical, MN, USA) was used to conform the thermal burn to the corpus callosum along the trajectory of the probe. The distance of the ideal entry site from either the coronal suture and the torcula or nasion and the midline was calculated. The distance of the probe tip from the dorsal and ventral limits of the callosotomy in the sagittal plane were also calculated.

Results

Anterior two-thirds callosotomy was possible in all patients using a posterior parieto-occipital paramedian trajectory through the non-dominant lobe. The average entry point was 3.64 cm from the midline, 10.6 cm behind the coronal suture, and 9.2 cm above the torcula. The probe tip was an average of 1.4 cm from the anterior commissure. For a total callosotomy, an additional contralaterally placed frontal probe was used to target the posterior one-third of the corpus callosum. The average entry site was 3.3 cm from the midline and 9.1 cm above the nasion. The average distance of the probe tip from the base of the splenium was 0.94 cm.

Conclusion

The directional thermoablation capability of the NeuroBlate® system allows for targeted lesioning of the corpus callosum, to achieve a two-thirds or complete corpus callosotomy. A laser distance of < 2 cm is sufficient to reach the entire corpus callosum through one trajectory for an anterior two-thirds callosotomy and two trajectories for a complete callosotomy.



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Harminder Singh, Assistant Professor, M.D.

Department of Neurosurgery, Stanford University Medical Center

For correspondence:
harman@stanford.edu

Walid I. Essayed

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Sayantan Deb

Medical School, Stanford University School of Medicine

Caitlin Hoffman

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Theodore H. Schwartz, M.D.

Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Harminder Singh, Assistant Professor, M.D.

Department of Neurosurgery, Stanford University Medical Center

For correspondence:
harman@stanford.edu

Walid I. Essayed

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Sayantan Deb

Medical School, Stanford University School of Medicine

Caitlin Hoffman

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York

Theodore H. Schwartz, M.D.

Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York