Functional outcomes of minimally invasive surgery treatment for patients with small supratentorial spontaneous intracerebral haematoma less than 30 mL: a propensity score matching study.

Background: This study investigated the efficacy of frameless robot-assisted stereotactic aspiration coupled with catheter thrombolysis (SA-CT) in treating supratentorial spontaneous intracerebral haemorrhage (sICH) with small haematoma volumes (<30 mL).

Methods: We analysed the clinical and long-term outcome data for patients who had haematoma volumes <30 mL and underwent SA-CT between August 2019 and June 2023. Then, we matched the patients receiving conservative treatment during the same period from a multicentre intracerebral haemorrhage database using propensity score matching. The outcomes included the restoration of independent standing ability and mortality within 1 year after onset.

Results: 340 patients were included in the final analysis. A greater proportion of patients in the surgery group regained the ability to stand independently within 1 year (89.1% vs 78.1%, p=0.049). The Kaplan-Meier curve showed that the cumulative standing rate in the surgery group was higher than that in the conservative group (90.4% vs 82.0%, p=0.007) within 1 year, and the median time to regain standing was shorter in the surgery group (30 days vs 34 days). The mortality rates were lower in the surgery group (p<0.05). Multivariate Cox regression analysis revealed that frameless robot-guided SA-CT (adjusted HR 1.80; 95% CI 1.37 to 2.38; p<0.001), age, haematoma volume, the severe Glasgow Coma Scale scores and pneumonia were independent factors associated with standing recovery within 1 year after onset.

Conclusions: Frameless robot-guided SA-CT for small supratentorial haematoma with contralateral hemiplegia seems safe and potentially facilitates the recovery of independent standing ability and reduces the mortality rates.