An MRI-Guided Robotic System to Improve Hippocampal Access for Epilepsy Interventions

Predicting post-surgical seizure outcomes in pharmacoresistant epilepsy is a clinical challenge. Conventional deep-learning approaches operate on static, single-timepoint pre-operative scans, omitting longitudinal morphological changes. We propose Neuro-Oracle, a three-stage framework that: (i) distils pre-to-post-operative MRI changes into a compact 512-dimensional trajectory vector using a 3D Siamese contrastive encoder; (ii) retrieves historically similar surgical trajectories from a population archive via nearest-neighbour search; and (iii) synthesises a natural-language prognosis grounded in the retrieved evidence using a quantized Llama-3-8B reasoning agent. Evaluations are conducted on the public EPISURG dataset ($N{=}268$ longitudinally paired cases) using five-fold stratified cross-validation. Since ground-truth seizure-freedom scores are unavailable, we utilize a clinical proxy label based on the resection type. We acknowledge that the network representations may potentially learn the anatomical features of the resection cavities (i.e., temporal versus non-temporal locations) rather than true prognostic morphometry. Our current evaluation thus serves mainly as a proof-of-concept for the trajectory-aware retrieval architecture. Trajectory-based classifiers achieve AUC values between 0.834 and 0.905, compared with 0.793 for a single-timepoint ResNet-50 baseline. The Neuro-Oracle agent (M5) matches the AUC of purely discriminative trajectory classifiers (0.867) while producing structured justifications with zero observed hallucinations under our audit protocol. A Siamese Diversity Ensemble (M6) of trajectory-space classifiers attains an AUC of 0.905 without language-model overhead.

Safe navigation within the spinal subarachnoid space is constrained by its narrow, compliant, and delicate anatomy. Conventional catheters and continuum robots rely on proximal pushing, generating friction and shear along the tissue device interface that limit distal controllability and increase the risk of neural injury. Here, we present a 2 mm diameter eversion-growing robotic platform that enables friction minimised extension and steering within the human spinal subarachnoid space, validated through computational modelling, phantom experiments, and intact human cadaver studies. The robot integrates a miniature endoscope for real time intrathecal visualisation and advances by pressure driven tip eversion, localising motion to the distal tip while minimising translational sliding of the deployed body. Phantom experiments demonstrated reductions of 65.2% in mean interaction force and 48.0% in peak interaction force compared with matched push-based insertion. Physics based modelling showed that eversion based growth redistributed tissue loading, reducing local stress concentrations and interfacial shear relative to conventional insertion. In an intact human cadaver, the system achieved 150 mm of controlled intrathecal extension with concurrent fluoroscopic and endoscopic visualisation, providing access across multiple vertebral levels from a standard lumbar entry point. Postprocedural laminectomy and durotomy revealed no observable macroscopic disruption of the dura mater or surrounding neural structures. These results provide the first mechanically characterised and multimodally validated demonstration of eversion-based robotic navigation in intact human spinal anatomy, establishing a quantitative and procedural foundation for future intrathecal interventions. Further validation in larger anatomical cohorts and under physiological conditions will be required before clinical translation.

Computational models of epilepsy promise patient-specific treatment design, but most optimization workflows still search for parameters that perform well on average. In neuromodulation, this is a weak target: a protocol that improves the mean response can still fail in the patient whose network is least tolerant to stimulation. We present a literature-guided minimax pipeline that couples PubMed-scale hypothesis extraction, The Virtual Brain (TVB) Epileptor simulations, and large-language-model-guided black-box optimization. The optimizer proposes either intrinsic model-control parameters or clinically interpretable external-stimulation protocols; TVB evaluates each proposal across sampled virtual patients; and the objective maximizes worst-case reward, defined as the negative variance of simulated seizure activity. In the intrinsic model-control experiment, the best archived parameter set improved worst-case reward from -0.5285 to -0.3182, a 39.8% gain over baseline. The clinical-style external-stimulation search produced a much smaller worst-case improvement (1.7%), and a 20-patient virtual cohort showed no aggregate benefit (p=0.9019), despite a 55% responder rate and a positive temporal-lobe subgroup signal. The study should be read as an in silico proof of concept for robust, literature-aware neurostimulation design, not as clinical evidence.