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Oregon’s first brain surgery with a robotic assist

Hoops fan with epilepsy undergoes brain surgery with robotic guidance
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Bryan Black, 34, uses a hand-held scanner to receive data from a device that monitors his brain activity. Black is the first patient in Oregon to undergo brain surgery with with an assist from a robot. The ROSA (Robotic Stereotactic Assistance) robot was utilized to place electrodes in Black's brain to treat epilepsy. (OHSU/Kristyna Wentz-Graff)

Bryan Black may be best known as the college basketball fan who has leveraged social media to collect hundreds of jerseys donated by Division I basketball programs rooting for his success in fighting epilepsy.

Last week, the 34-year-old Monmouth resident earned distinction as the first patient in Oregon to undergo brain surgery with an assist from a robot.

The assist was dished out by the ROSA, or Robotic Stereotactic Assistance, robot, which neurosurgeons at OHSU used to place electrodes in Black’s brain. The procedure, performed by Ahmed Raslan, M.D., associate professor of neurological surgery in the OHSU School of Medicine, provides precise GPS-like imagery to guide placement of needle-like electrodes inside the brain.

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The responsive neurostimulation system, or RNS, is surgically placed within the skull and positions small wires into the area of the brain where the seizures begin. Continuously monitoring brain activity, the device delivers a small burst of electrical stimulation that can stop seizures before they begin, and reduce seizures over time. (OHSU/Erik Robinson)

The electrodes mapped the exact location in his brain where his seizures originate.

Black’s physicians reported that the inaugural procedure went smoothly, providing a faster and minimally invasive alternative for placing diagnostic electrodes – a procedure called stereo-electroencephalography, or SEEG. OHSU will use the robotic assistance for all SEEG cases involving children and adults with epilepsy, and Raslan noted that it eventually may be used for other neurosurgical and spinal procedures.

“It will make surgery safer and faster for patients with epilepsy and, eventually, other types of patients as well,” Raslan said.

Using the robotic assistance, Raslan passed thin wires into the brain through tiny holes. Not only is the device precise, accurate and easier than conventional craniotomies, Raslan said the patient can recover more quickly.

Rosa Brain robot
ROSA Brain is a surgical navigation and positioning system using robotic technology that allows surgeons to place electrodes, which detect seizures in the brain, without having to open a patient’s skull or even shave a patient’s head, as other traditional methods require. (Courtesy of Zimmer Biomet)

Black would attest to that.

“All hooked up at OHSU!” he tweeted via his handle, @353jerseys4hope. “I’ve got my jerseys on the way!! Thanks for all the support everybody! And thanks to all of the journalists, coaches, players and fans for believing in me! #Epilepsy.”

A high-tech implant

Less than a week following the initial procedure on Aug. 14, doctors had the information they needed to conduct the final stage of Bryan’s treatment: On Tuesday, he became the 20th patient in Oregon to be implanted with an advanced device designed to monitor brain activity and stop seizures before they begin. The responsive neurostimulation system, or RNS, is surgically placed within the skull and positions small wires into the area of the brain where the seizures begin. Continuously monitoring brain activity, the device delivers a small burst of electrical stimulation that can stop seizures before they begin, and reduce seizures over time. 

OHSU is the only hospital in Oregon that provides this technology to treat epilepsy.

Lia Ernst, M.D., assistant professor of neurology in the OHSU School of Medicine and director of adult epilepsy surgery, said it will take at least a year to determine whether the device has significantly reduced the number of seizures that affected Black daily. The first RNS device was implanted at OHSU on the last day of 2015, one of several surgical options for the more than a third of epilepsy patients whose seizures aren’t controlled by medication.

Ernst also supports Bryan’s personal cause to promote research and treatment for epilepsy, which affects about 3.4 million people in the United States, according to the U.S. Centers for Disease Control and Prevention.

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