title: Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept.
abstract: BACKGROUND
  We describe the feasibility of using minimally invasive robotic laser interstitial thermotherapy (LITT) for achieving an anterior two-thirds as well as a complete corpus callosotomy.
  
  
  METHODS
  Ten probe trajectories were plotted on normal magentic resonance imaging (MRI) scans using the Brainlab Stereotactic Planning Software (Brainlab, Munich, Germany). The NeuroBlate® System (Monteris Medical, MN, USA) was used to conform the thermal burn to the corpus callosum along the trajectory of the probe. The distance of the ideal entry site from either the coronal suture and the torcula or nasion and the midline was calculated. The distance of the probe tip from the dorsal and ventral limits of the callosotomy in the sagittal plane were also calculated.
  
  
  RESULTS
  Anterior two-thirds callosotomy was possible in all patients using a posterior parieto-occipital paramedian trajectory through the non-dominant lobe. The average entry point was 3.64 cm from the midline, 10.6 cm behind the coronal suture, and 9.2 cm above the torcula. The probe tip was an average of 1.4 cm from the anterior commissure. For a total callosotomy, an additional contralaterally placed frontal probe was used to target the posterior one-third of the corpus callosum. The average entry site was 3.3 cm from the midline and 9.1 cm above the nasion. The average distance of the probe tip from the base of the splenium was 0.94 cm.
  
  
  CONCLUSIONS
  The directional thermoablation capability of the NeuroBlate® system allows for targeted lesioning of the corpus callosum, to achieve a two-thirds or complete corpus callosotomy. A laser distance of < 2 cm is sufficient to reach the entire corpus callosum through one trajectory for an anterior two-thirds callosotomy and two trajectories for a complete callosotomy.
authors.affiliation: Neurosurgery, Stanford University Medical Center.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Walid I
authors.initials: WI
authors.lastname: Essayed
authors.affiliation: Medical School, Stanford University School of Medicine.
authors.forename: Sayantan
authors.initials: S
authors.lastname: Deb
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Hoffman
authors.affiliation: Weill Cornell Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
keywords: corpus callosotomy; laser interstitial thermotherapy; minimally invasive