Neurologists and neurosurgeons are offering new, minimally invasive diagnostic tests and surgical procedures at Cincinnati Children’s, thanks to the addition of several advanced technologies.

TMS for Functional Brain Mapping

In October 2015, Cincinnati Children’s began using transcranial magnetic stimulation (TMS) to perform functional mapping prior to surgery for brain lesions and epilepsy. “Previously, we had two ways of identifying eloquent areas of the brain,” says Hans Greiner, MD, co-director of the epilepsy program at Cincinnati Children’s. “We could do a craniotomy with electrode placement, or functional magnetic resonance imaging, which can be challenging in young patients. This new, non-invasive technology uses TMS to measure the activity and function of specific brain circuits in patients as young as two years old. It builds on our experience with TMS, a technology we have been using since 2001 to evaluate children with movement disorders and other neurologic conditions.”

Expanded Minimally Invasive Surgery Capabilities

In late 2016, the Division of Neurosurgery made significant technology upgrades to its surgical suites. This included purchasing the ROSA® operating system, stereotactic electroencephalogram equipment and a next-generation intraoperative MRI magnet.

ROSA consists of a robotic arm and monitor that are used for less invasive epilepsy procedures, thermal laser ablation for brain tumors, certain skull-based procedures, and brain endoscopy. One of ROSA’s main uses is the localization of seizure onset zones, as an alternative to placing a subdural grid.

“The robotic arm holds needle-thin tools that we can use to make burr holes in the skull for electrode placement,” says Francesco Mangano, DO, chief of pediatric neurosurgery at Cincinnati Children’s. “With the help of stereotactic EEG, we can place electrodes deep in the brain, not just on the lateral surface, which improves our accuracy in mapping the seizure focus. After EEG monitoring is complete, we can send the patient home and take time to plan an elective resection. This is a great advantage over doing EEG monitoring and resection during one hospital stay.”

The new intraoperative MRI magnet is the centerpiece of a larger upgrade to the magnetic resonance surgery suite. Other improvements include additional space to do more invasive procedures in the magnet, new lights for greater visibility and larger, drop-down monitors to aid in stereotactic guidance.

Neurosurgeon Develops Smartphone App for Hydrocephalus Patients

Jesse Skoch, MD, neurosurgery, recently developed a smartphone app with the Hydrocephalus Association. Called HydroAssist, it is the first mobile app that allows patients with hydrocephalus to store critical medical information, such as their treatment history and shunt settings.