Efficacy of robot-assisted minimally invasive stereotactic puncture therapy for supratentorial hypertensive intracerebral hemorrhage

Objective: To evaluate the efficacy of robot-assisted minimally invasive stereotactic puncture therapy (MISPT) for supratentorial hypertensive intracerebral hemorrhage (HICH). Methods: We retrospectively analyzed 133 patients with supratentorial HICH treated using robot-assisted MISPT (RM group; n = 77) or conventional craniotomy (CC group; n = 56). In our primary analysis, we evaluated the hematoma volume at discharge. In our secondary analyses, we evaluated the Glasgow Coma Scale (GCS) score at discharge; the operation time, intraparenchymal drainage catheter removal time, the length of hospital stay, and complications during hospitalization; the early and 6-month postoperative mortality; and functional scores 6-month postoperatively. Results: There were no statistical differences in the preoperative characteristics between the groups, such as age distribution (52.8 +/- 9.6 vs. 55.3 +/- 7.8 years), hematoma volume (38.4 +/- 10.4 vs. 41.1 +/- 11.0 mL), and GCS score (10.7 +/- 2.2 vs. 9.8 +/- 2.8). Hematoma volume at discharge did not significantly differ between the groups (2.6 +/- 2.1 mL vs. 2.4 +/- 2.1 mL). The GCS score at discharge was significantly higher in the RM group (13.5 +/- 2.1 vs. 11.6 +/- 3.1; p < .001). Operation time (40.3 +/- 7.0 min vs. 143.1 +/- 61.3 min;p < .001), intraparenchymal drainage catheter removal time (1.2 +/- 0.4 vs. 2.1 +/- 0.7 days; p < .001), and length of hospital stay (9.3 +/- 2.7 vs. 11.1 +/- 4.8 days; p = .013) were significantly shorter in the RM group. The incidence rates of pneumonia, gastrointestinal bleeding, and intracranial infection were significantly lower in the RM group. Although the incidence of rebleeding was lower in the RM group (1.3% vs. 5.4%), the difference was not significant. Six months after surgery, the Barthel Index, Glasgow Outcome Scale, and Karnofsky performance status scores were significantly higher, whereas the modified Rankin scale score was significantly lower in the RM group (p = .002, p = .007, p = .001, and p = .018, respectively). Two RM group patients (3.1%) and six CC group patients (12.2%) died between hospital discharge and 6 months after surgery (p = .127). Conclusion: The main advantages of robot-assisted MISPT for supratentorial HICH were shown in minimally invasive, precision, and low incidences of complications. In addition, it may improve the prognosis significantly. Thus, it has great potential to be popularized and clinically applied in the future.