With guidance from a surgical robot, Dr. David Sun drilled a tiny hole into the skull of Justin Hardesty, 34, and inserted a laser probe into his brain to burn away some unhealthy tissue that had been causing occasional, but intense seizures.
Some days, Hardesty had three or four of the seizures, which he compared to panic attacks.
“It would kind of wipe me out for a day,” he told Insider.
Medication had allowed Hardesty to control the seizures for the most part, but he worried about building a tolerance and the medication becoming ineffective.
Hardesty, a Chicago native who has lived in Louisville since high school, was diagnosed with epilepsy at age 8. Thanks to medication, his grand mal seizures have been under control, but the secondary seizures that began in his mid-20s have worried him with increasing severity.
Hardesty says he pays for the expensive medications, which can cost thousands of dollars a month, with Supplemental Security Income, a government benefit for disabled adults and children who have limited income and resources.
He lives with his sister and told Insider that epilepsy did not affect him much, except that it prohibits him from driving. However, when the secondary seizures popped up, he wanted them to be addressed right away.
“Holy crap, these are intense,” he remembers thinking.
Until recent technological advances, however, surgeries to pinpoint the part of the brain in which the seizures originated — and removing the damaged tissue — were too risky.
In 2016, his neurologist referred Hardesty to Sun, who introduced him to ROSA, a surgical robot that, Sun said, is offering patients more — and better — options.
“Not only does (ROSA) allow us to do things that we couldn’t do before, it allows us to do them safer and faster, which is good for the patient and is actually good for me,” Sun said.
ROSA allows for smaller incisions, lowers the risk of bleeding and infection, accelerates patient recovery and increases the surgeon’s accuracy, he said.
“I make the plan, but the robot allows me to execute my plan cleaner, faster, safer,” said Sun, a neurosurgeon with Norton Healthcare’s Norton Neuroscience Institute.
Hardesty’s neurologist determined that the secondary seizures were related to the epilepsy and put him on additional medication, Topamax, which reduced the frequency and severity of the seizures.
Once Sun had determined, with the help of ROSA, where the secondary seizures originated, he laid out the main options for the patient: Resection, or a surgical removal of the part of the brain that’s causing the seizures, or laser ablation, which, with the help of ROSA, uses an image-guided laser to destroy the affected area.
Hardesty said resection did not seem like a viable option because it would have meant using a scalpel to remove a healthy piece of the brain before the surgeon could even get to the section that was causing the seizures.
Instead, the ablation procedure allowed Sun to use ROSA to guide the laser probe to the affected area without removing any healthy part of the brain and fire up the laser to kill the cells that were causing the problem.
Sun said he encounters similar situations in patients with brain tumors.
As he looked at a computer screen that displayed scans from a cancer patient’s brain, Sun said that to even reach a tumor, surgeons often have to go through healthy tissue, and they have to open a big enough hole to get in their surgical tools.
ROSA, on the other hand, allows the surgeon to cut a much smaller hole and guide the laser to the correct spot. The surgeon then steps on a pedal that passes energy to the laser to burn the tumor from the inside out. Constant imaging lets the surgeon see where the heat is spreading. He can step off the pedal to let the laser cool or twist the device to send the heat into a different direction. The body breaks down the dead tissue over time.
Such surgeries will not help all brain tumor patients, Sun emphasized, but the technology gives patients more options. For some patients, it’s the only option.
Some patients, whose epilepsy is caused by areas that are deep in the brain, previously may not have had any option to even determine the origins of the problem, because resection would have required removing too much of the healthy brain.
“The surgeon would say, ‘It’s just too much to put somebody through,’ ” Sun said.
“With the new technologies and our better understanding (of the) way the brain works … we’re opening doors for patients that we never opened doors for before,” he said.
Hardesty said that he felt “relatively good” when he woke up from the surgery in December 2016, though he had an intense headache. He stayed in the hospital for about two days. For two weeks after his release, he had to take things slowly, just for precaution. He felt fine, he said, and “was amazed” at how quickly he recovered.
And since the surgery, he has not experienced any secondary seizures.
“Amazing,” he said.
His neurologist has slowly been weaning him off his anti-seizure medication. This week is the first that he is not scheduled to take any.
For Hardesty, not having to buy the drugs means much more than saving money. He said he is on Supplemental Security Income solely to help pay for thousands of dollars of medications and doctor visits. But he cannot work so long as he receives the benefit, though he has held jobs here and there including in roofing, duct and demolition work.
If the surgery allows him to live without the meds, Hardesty said he can drop SSI, and pursue a career. That’s exciting to him, he said, in part because the last time he thought about a career, he was still a child.
Excited by the possibilities
Sun said that one of the newest ways to use ROSA involves placing a small computer into the brain of a seizure patient to record electrical activity in that area around the clock. The patient downloads the data once per day and allows neurologists to analyze the information.
Eventually, the doctors will be able to detect patterns of neurological activity that occur right before a seizure so that the small computer can emit a small dose of electricity in that area to abort the seizure before it happens. The dose will be so small that the patient won’t even know that it has happened.
Sun said he is excited about the possibilities, which could include anything from curbing binge eating to augmenting memory.
“There’s all kinds of things out there that we can get to someday,” he said.
Sun said that he expects robots to play an ever greater role in surgical techniques and aiding humans to perform operations with greater accuracy, speed, safety and success.
However, he said he expects some functions to remain solely in the domain of humans.
“My job, unfortunately, sometimes is to sit down with a patient and their family and explain to the that they’ve got a bad diagnosis. We’re never going to design a robot, I think, that’s going to do that as well as I do, because it’s hard to do, it’s sad to do,” he said.
“There’s an art and a science to what we do,” Sun said. “The robot’s not going to replace the art part. It might help us with the science part, but we’re going to have a role.”
Join Insider Louisville July 24 for Rise of the Robots, a discussion with local experts, including Dr. Sun, on the ways in which robots and AI are affecting the local economy.