The authors present a new “bloodless” technique for minimally invasive robotic thermocoagulative hemispherotomy (ROTCH). Such a method is being described in the literature for the first time.

A robotic system was used to plan five sets of different trajectories: anterior disconnection, middle disconnection, posterior disconnection, corpus callosotomy, and temporal stem and amygdalar disconnection. A special technique, called the “X” technique, allowed planar disconnection. Registration was performed with surface landmarks (n = 5) and bone fiducials (n = 1). Coregistration with O-arm images was performed one or two times to confirm the trajectories (once for middle disconnection, and once for disconnection of the temporal stem and amygdala or body of the corpus callosum). Impedance measured before ablation allowed for minor adjustments. Radiofrequency ablation was performed at 75°C–80°C for 60 seconds. Surgical procedures were performed with multiple twist drills. After removal of the electrode, glue was used to prevent CSF leak, and a single stitch was applied. Follow-up CT and MRI were immediately performed.

The pathologies included Rasmussen's encephalitis (n = 2), hemispheric cortical dysplasia (n = 2), posttraumatic encephalomalacia (n = 1), and perinatal insult (n = 1). The mean ± SD (range) age was 6.7 ± 3.6 years (5 months to 10.2 years), and the right side was affected in 4 patients. The mean ± SD seizure frequency was 7.4 ± 5.6 seizures per day (1 patient had epilepsia partialis continua). The mean ± SD number of trajectories was 15.3 ± 2.5, and the mean ± SD number of lesions was 108 ± 25.8. The mean ± SD maximum numbers of trajectories and lesions required for middle disconnection were 7.1 ± 1.7 and 57.5 ± 18.4, respectively. All but 1 patient had class 1 outcomes according to the International League Against Epilepsy Outcome Scale at a mean ± SD (range) follow-up of 13.5 ± 1.6 (12–16) months; the remaining patient had a class 2 outcome. The estimated blood loss was < 5 ml for all patients. Complications included repeat surgery (after 2 weeks) for a “skip” area (n = 1) and a small temporal hematoma (n = 1), which resolved.

ROTCH seems to be a safe, feasible, and bloodless procedure, with a very low morbidity rate and promising outcomes.

作者提出了一种新的“无血”技术，用于微创机器人热凝半球切开术 (ROTCH)。这种方法是第一次在文献中描述。

机器人系统被用来规划五组不同的轨迹：前断路、中间断路、后断路、胼胝体切开术、颞干和杏仁核断路。一种称为“X”技术的特殊技术允许平面断开。使用表面标志 (n = 5) 和骨骼基准 (n = 1) 进行配准。使用 O 臂图像进行配准一两次以确认轨迹（一次用于中间断开，一次用于颞干和杏仁核或胼胝体的断开）。消融前测量的阻抗允许进行微小调整。射频消融在 75°C–80°C 下进行 60 秒。手术过程是用多个麻花钻进行的。取出电极后，用胶水防止脑脊液漏，并且只缝了一针。立即进行了随访 CT 和 MRI。

病理包括拉斯穆森脑炎 (n = 2)、半球皮质发育不良 (n = 2)、创伤后脑软化症 (n = 1) 和围产期损伤 (n = 1)。平均 ± SD（范围）年龄为 6.7 ± 3.6 岁（5 个月至 10.2 岁），4 例患者右侧受累。平均 ± SD 癫痫发作频率为每天 7.4 ± 5.6 次癫痫发作（1 名患者患有部分持续性癫痫）。轨迹的平均值 ± SD 数为 15.3 ± 2.5，病变的平均值 ± SD 数为 108 ± 25.8。中间断开所需的平均 ± SD 最大轨迹和病变数分别为 7.1 ± 1.7 和 57.5 ± 18.4。根据国际抗癫痫联盟预后量表，除 1 名患者外，所有患者均在 13.5 ± 1.6 (12-16) 个月的平均 ± SD（范围）随访中达到 1 级结局；其余患者的结果为 2 级。所有患者的估计失血量 < 5 ml。并发症包括对“跳跃”区域 (n = 1) 和小的颞部血肿 (n = 1) 进行重复手术（2 周后），但已解决。

ROTCH 似乎是一种安全、可行和不流血的手术，发病率非常低，结果很有希望。