Safety and efficiency of robot-assisted aspiration and intraoperative lysis without catheterization for deep-seated intracerebral hemorrhage.

Abstract

Functional recovery after minimally invasive surgery for intracerebral hemorrhage (ICH) varies. In this study, we introduce a novel robot-assisted stereotactic aspiration and lysis procedure to evacuate deep-seated ICH and evaluate the efficiency of improving neurologic outcomes. Adult patients with spontaneous ICH less than 40 mL were prospectively recruited and underwent a novel protocol combining aspiration and lysis through a single trajectory planned and executed with a neurosurgical robot. No catheter drainage was required after each procedure. The clot volume and neurologic assessments including Glasgow Coma Scale (GCS), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were compared before and after surgery. Surgical complications and mortality within 30 days and neurological improvement survival (NIS), defined as the day on which the NIHSS had decreased by 3 points postoperatively, were recorded. Fifty-five patients with a mean clot volume of 25.5 mL and ICH score of 2 were enrolled. The overall reduction rate was 84.3%, which was inversely proportional to the initial volume (-0.42, p = 0.041). One patient (1.8%) had subclinical bleeding postoperatively, however, none of the patients died. Comparisons between before and after surgery showed an increase in GCS (11.7 vs. 13.4, p < 0.001), decrease in NIHSS (17.4 vs. 12.1, p < 0.001), and decrease in mRS (3.6 vs. 3.1, p < 0.001). Right hemisphere ICH was associated with better NIS than left ICH (p = 0.025). Robot-assisted stereotactic aspiration and thrombolysis can effectively improve neurological function in patients with deep-seated ICHs.