Laser Ablation of a Nonlesional Cingulate Gyrus Epileptogenic Zone Using Robotic-Assisted Stereotactic EEG Localization: A Case Report

Background: Nonlesional cingulate gyrus epilepsy is rare, difficult to diagnose, and challenging to treat. Methods: We report the use of ROSA (Medtech Surgical, Inc., New York, NY, USA) robotic assistance for stereotactic EEG (S-EEG) localization and therapeutic thermal laser ablation of a nonlesional cingulate gyrus epileptogenic zone in a 17-year-old female with intractable partial epilepsy. Results: After an inconclusive exhaustive initial workup, robotic-assisted S-EEG localized the patient’s seizure focus to the right cingulate gyrus. Robotic-assisted lesioning of the cingulate gyrus was performed via 5 total ablations with 3 minimally invasive catheters. There were no perioperative complications. The patient was discharged home on postoperative day 2 at her neurologic baseline. She was seizure free for 8 months postoperatively, with a sustained partial response through the 23-month follow-up. Conclusions: This report expands the technical uses, pathologies, and patient populations being treated via robotic-assisted neurosurgery.