Robot-assistant visualized minimally invasive aspiration (RAVMIA) technique for intracerebral hemorrhage evacuation: Case series.

Background And Importance: The surgical management of intracerebral hemorrhage (ICH) remains controversial due to unfavorable outcomes reported in several influential clinical trials. There is a pressing need for novel instrumentation and approaches that optimize evacuation efficiency while minimizing invasiveness. Among the emerging techniques, endoscopic surgery and robot-assisted minimally invasive catheterization (robotic MISTIE) show potential. However, the former still results in brain damage at a centimeter level, while the latter exhibits low evacuation efficiency due to its non-visualized nature.

Methods: We have developed a novel technique called robot-assisted visualized minimally invasive aspiration (RAVMIA) for the evacuation of ICH. This technique integrates neurosurgical robot navigation, contact-visible endoscopy, and minimally invasive catheterization. The efficacy of RAVMIA was evaluated using robotic MISTIE as a historical control.

Results: The RAVMIA technique was successfully implemented in three cases of ICH without complications. Brain damage was limited to 5mm. Compared to robotic MISTIE, RAVMIA did not prolong operative time (20.67 ± 4.04 minutes vs. 20.87 ± 5.74 minutes, p = 0.946) but significantly increased the intraoperative hematoma evacuation rate from 80.8 ± 4.1 % to 86.6 ± 1.3 % (p = 0.003). Consequently, the end-of-treatment residual ICH volume decreased from 5.3 ± 2.95 ml to 1.3 ± 1.05 ml (p = 0.004), and the hospital stay was reduced from 12.87 ± 4.55 days to 10.67 ± 4.04 days (p = 0.029).

Conclusion: The preliminary application of the RAVMIA technique demonstrates its safety and feasibility in treating long, oval-shaped basal ganglia hematoma and brain stem hematoma. This method achieves high evacuation efficiency while minimizing invasiveness. Further technical optimization and clinical trials are warranted to fully explore its potential.