ROSA™ and Minimally Invasive Brain Surgery May Cure Epilepsy

ROSA™ just might be 7-year-old Brynn Mulrooney’s new best friend. While ROSA™ doesn’t swing with her on the monkey bars at recess or ride bikes with her after school, ROSA™ gave Brynn a gift that changed her life—no more seizures.

ROSA™ is a robot with a big brain and a robotic arm that lives at Lucile Packard Children’s Hospital Stanford. She helps Gerald Grant, MD, Neurosurgery Division Chief, and pediatric epilepsy neurologists with the Packard Children’s Pediatric Epilepsy Center, give kids with uncontrolled epileptic seizures a powerful option to explore when medications are not working. Along with a precise laser, ROSA™ the robotic surgical assistant for 3-D mapping empowers surgeons to target the exact source of epileptic seizures in the brain and vaporize them. Lucile Packard Children’s Hospital is the first hospital in Northern California to have ROSA™.

At age 5, Brynn experienced her first seizure while lying in a dental chair. Since it takes two seizures to diagnose epilepsy, the second came four days later at home in Woodinville, Washington. Despite trying 13 different medications over the next two years, Brynn’s seizures continued to get worse. Eventually, Brynn was having up to 12 seizures a day. It was a scary, terrible time for the family.

“When she had her first seizure, we had no idea about epilepsy,” says Michelle Mulrooney, Brynn’s mom. “We did a ton of research and my husband Brian would track her seizures in Excel so we could report when they happened and how long they lasted. We were desperate for control.”  

While medications often work to control seizures, there is no cure for epilepsy. Yet, ROSA™ and minimally invasive brain surgery using lasers are changing that. The family moved to Granite Bay, California to be close to relatives, and close to Lucile Packard Children’s Hospital.

“The first time I met Brynn she had a seizure in my office,” says Dr. Hyunmi Kim, a highly trained neurologist who specializes in epilepsy, called an epileptologist. “We tried different medications with some improvement for a few months. Then Brynn had a prolonged seizure that lasted up to 15 minutes, so we hospitalized her. Soon after, we talked about surgery.”

Before ROSA™ could assist with Brynn’s laser surgery, doctors needed to create a flawless 3D map of Brynn’s brain to precisely identify where her seizures were originating. The Synaptive Medical platform overlapped several tests, including a PET scan, MEG, and various MRIs, to map brain structure and seizure onset and spread. These tests were scrupulously studied by a multidisciplinary team of over 20 experts—including neurosurgeons, epileptologists, clinical neurophysiologists, neuropsychologists, and neuroradiologists —to search for clues about Brynn’s brain activity. Finally, a stereo EEG was performed to place several electrodes into Brynn’s brain.

“A lot of detailed planning goes into a stereo EEG. For example, we run high resolution sequences on MRI so we can see very small blood vessels in the brain to enhance patient safety,” Dr. Grant says.

Dr. Grant, with the help of ROSA™, created tiny holes in Brynn’s skull. Under image guidance, he then placed 18 fine electrodes to record activity deep in her brain. The electrodes stayed in place for two weeks, under a large head wrap, while doctors stimulated various electrodes waiting for seizures.    

“Brynn’s parents were super helpful by pushing a button when they noticed anything suspicious while the electrodes were in place. It took several days for Brynn to have her first seizure with the electrodes, but Brynn and her parents waited very patiently for her first seizure,” Dr. Grant says.

The final step was the minimally invasive brain surgery to cure the seizures. First, doctors integrated the 3D imaging and electrical road map in the intraoperative MRI. Next, Dr. Grant precisely guided the laser to the target. When the laser was turned on, he was able to see the heat map generated by the laser, using MRI to ablate tiny targets deep in the brain.

“We brought together multiple innovative technologies to achieve the best possible outcome for Brynn,” Dr. Grant says. “Brynn’s deep targets were surrounded by areas of high real estate which were super important for her speech. It’s a huge advance for us to travel right up against deep highways in the brain to ablate an area causing the seizures that was the size of a walnut. The goal was to cure her epilepsy without taking anything away from her quality of life and sweet smile.”

“Brynn handled the surgery really well and was out of the hospital in two days. She always had her eye on the prize,” Brian says. “We chose Stanford because they had ROSA™, and Dr. Grant was amazing. With Stanford, you don’t get one or two doctors, you get a whole team working together with multiple minds deciding the next step. It’s really reassuring.”

Brynn’s current EEG is nice and quiet and she has already been taken off a few medications. Dr. Kim’s goal is to cautiously wean Brynn from her special KETO diet and eventually from all but one medication.  

“Michelle and Brian were great partners to work with. They were very diligent and patient, which is what it takes,” Dr. Kim says. “Brynn herself is adorable. She never complained.”

Michelle returns the compliment, telling how Dr. Kim and her team were available every hour of the day or night to answer questions. Brynn describes her brain surgery as ‘no big deal.’ Just the other day, she announced to her parents, ‘I don’t get seizures anymore.’ She loves nature, insects, fishing, dragons and playing with her sister Maren, age 5.

Brynn is thriving in first grade. She says recess is the favorite part of her day. She might not have ROSA™ to play with, but she knows it was ROSA™ and the multidisciplinary team at Packard Children’s that gave her the priceless gift of seizure-free fun.

Learn more about our Pediatric Epilepsy Center >