Robot-assisted neurosurgery versus conventional treatment for intracerebral hemorrhage: A systematic review and meta-analysis

Efficacy and Prognosis of ROSA Robot-Assisted Stereotactic Intracranial Hematoma Removal in Patients with Cerebral Hemorrhage in Basal Ganglia Region: Comparison with Craniotomy and Neuroendoscopy

This study compares the clinical efficacy and outcomes of three surgical techniques-robot-assisted stereotactic assistance (ROSA), neuroendoscopy, and craniotomy-in the removal of intracranial hematomas in patients with cerebral hemorrhage affecting the basal ganglia. This retrospective study included 110 patients, who were grouped based on the surgical method used: 40 patients in the ROSA group, 50 in the craniotomy group, and 20 in the endoscopy group. We then compared the outcomes of the ROSA group with those of the craniotomy and endoscopy groups. Compared with the craniotomy group, the ROSA group had a significantly shorter operation time, higher hematoma clearance rate, lesser intraoperative blood loss, fewer postoperative pulmonary infections, and lower modified Rankin Scale (mRS) score at discharge and > 3 months after discharge. Compared with the endoscopy group, the ROSA group had a shorter operation time, lesser intraoperative blood loss, and fewer intraoperative blood transfusions. The ROSA robot provided superior surgical outcomes and patient prognoses compared to craniotomy and neuroendoscopy for the removal of intracranial hematomas in patients with basal ganglia cerebral hemorrhage.

Expanding Applications and Future of Robotic Microsurgery

Robotic-assisted microsurgery has emerged as a transformative technology, offering enhanced precision for complex procedures across various fields, including lymphatic surgery, breast reconstruction, trauma, and neurosurgery. This paper reviews current advancements, applications, and potential future directions for robotic-assisted microsurgery. In lymphatic surgery, robotic systems such as Symani have improved precision in thoracic duct reconstruction and lymphatic vessel anastomoses, reducing morbidity despite longer surgery times. In breast reconstruction, robotic systems are being used to refine techniques like the miraDIEP approach, minimizing tissue damage and enhancing precision in individualized treatments. Trauma reconstruction, particularly for extremities, has also benefited from robotic assistance, enabling successful sutures in small vessels and nerves. Emerging applications in meningeal lymphatics show potential for treating neurodegenerative diseases through improved drainage. In neurosurgery, robots enhance precision in deep and narrow anatomic spaces, although advancements in specialized instruments are needed for full implementation. Future development of robotic microsurgery systems will focus on improved maneuverability, miniaturization, and integration of tools like augmented reality and haptic feedback. The goal is to combine robotic precision, data storage, and processing with human skills such as judgment and flexibility. Although robots are unlikely to replace surgeons, they are poised to play an increasingly significant role in enhancing surgical outcomes. As the technology evolves, further research and clinical trials are needed to refine robotic systems and validate their expanding applications in clinical practice.

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.

Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques

Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.

Short-term outcomes of robot-assisted minimally invasive surgery for brainstem hemorrhage: A case-control study

Objective

This work focused on investigating if robot-assisted minimally invasive surgery improved middle term vital outcome for primary brainstem hemorrhage (PBSH).

Methods

This work obtained clinical data from patients with PBSH admitted from July 2019 to August 2021. All cases were classified as surgical or conservative treatment group. The general information, Glasgow coma scale (GCS) score, Glasgow outcome score (GOS), along with survival time in patients 60 days after robot-assisted surgery were recorded and analyzed.

Results

A prospective analysis was performed on 82 cases meeting eligibility criteria, including 36 from surgical group whereas 46 from the conservative group. Sixty days after onset, the death rate was found to be 19.44% and 50.00% of surgical and conservative groups, separately (cases versus controls, P < 0.05). Furthermore, postoperative GOS and GCS scores of surgical group were significantly higher, and hydrocephalus was lower compared with conservative group. Central fever incidence did not exhibit any significant difference between two groups.

Conclusion

Robot-assisted PBSH drainage may improve survivorship and reduce the occurrence of hydrocephalus.

Predicting the 90-day prognosis of stereotactic brain hemorrhage patients by multiple machine learning using radiomic features combined with clinical features

Hypertensive Intracerebral Hemorrhage (HICH) is one of the most common types of cerebral hemorrhage with a high mortality and disability rate. Currently, preoperative non-contrast computed tomography (NCCT) scanning-guided stereotactic hematoma removal has achieved good results in treating HICH, but some patients still have poor prognoses. This study collected relevant clinical and radiomic data by retrospectively collecting and analyzing 432 patients who underwent stereotactic hematoma removal for HICH from January 2017 to December 2020 at the Liuzhou Workers Hospital. The prognosis of patients after 90 days was judged by the modified Rankin Scale (mRS) scale and divided into the good prognosis group (mRS ≤ 3) and the poor prognosis group (mRS > 3). The 268 patients were randomly divided into training and test sets in the ratio of 8:2, with 214 patients in the training set and 54 patients in the test set. The least absolute shrinkage and selection operator (Lasso) was used to screen radiomics features. They were combining clinical features and radiomic features to build a joint prediction model of the nomogram. The AUCs of the clinical model for predicting different prognoses of patients undergoing stereotactic HICH were 0.957 and 0.922 in the training and test sets, respectively, while the AUCs of the radiomics model were 0.932 and 0.770, respectively, and the AUCs of the combined prediction model for building a nomogram were 0.987 and 0.932, respectively. Compared with a single clinical or radiological model, the nomogram constructed by fusing clinical variables and radiomic features could better identify the prognosis of HICH patients undergoing stereotactic hematoma removal after 90 days.

The Role of ICP Monitoring in Minimally Invasive Surgery for the Management of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is the second major stroke type, with high incidence, high disability rate, and high mortality. At present, there is no effective and reliable treatment for ICH. As a result, most patients have a poor prognosis. Minimally invasive surgery (MIS) is the fastest treatment method to remove hematoma, which is characterized by less trauma and easy operation. Some studies have confirmed the safety of MIS, but there are still no reports showing that it can significantly improve the functional outcome of ICH patients. Intracranial pressure (ICP) monitoring is considered to be an important part of successful treatment in traumatic brain diseases. By monitoring ICP in real time, keeping stable ICP could help patients with craniocerebral injury get a good prognosis. In the course of MIS treatment of ICH patients, keeping ICP stable may also promote patient recovery. In this review, we will take ICP monitoring as the starting point for an in-depth discussion.

Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions

Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.

Learning curves in robotic neurosurgery: a systematic review

The transition to performing procedures robotically generally entails a period of adjustment known as a learning curve as the surgeon develops a familiarity with the technology. However, no study has comprehensively examined robotic learning curves across the field of neurosurgery. We conducted a systematic review to characterize the scope of literature on robotic learning curves in neurosurgery, assess operative parameters that may involve a learning curve, and delineate areas for future investigation. PubMed, Embase, and Scopus were searched. Following deduplication, articles were screened by title and abstract for relevance. Remaining articles were screened via full text for final inclusion. Bibliographic and learning curve data were extracted. Of 746 resultant articles, 32 articles describing 3074 patients were included, of which 23 (71.9%) examined spine, 4 (12.5%) pediatric, 4 (12.5%) functional, and 1 (3.1%) general neurosurgery. The parameters assessed for learning curves were heterogeneous. In total, 8 (57.1%) of 14 studies found reduced operative time with increased cases, while the remainder demonstrated no learning curve. Six (60.0%) of 10 studies reported reduced operative time per component with increased cases, while the remainder indicated no learning curve. Radiation time, radiation time per component, robot time, registration time, setup time, and radiation dose were assessed by ≤ 4 studies each, with 0-66.7% of studies demonstrated a learning curve. Four (44.4%) of 9 studies on accuracy showed improvement over time, while the others indicated no improvement over time. The number of cases required to reverse the learning curve ranged from 3 to 75. Learning curves are common in robotic neurosurgery. However, existing studies demonstrate high heterogeneity in assessed parameters and the number of cases that comprise the learning curve. Future studies should seek to develop strategies to reduce the number of cases required to reach the learning curve.

Advanced surgical tool: Progress in clinical application of intelligent surgical robot

Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.

Clinical Study on a Modified Hematoma Puncture Drainage Treatment in Patients with Hypertensive Basal Ganglia Hemorrhage

OBJECTIVE

We aim to investigate the clinical efficacy and safety of a modified hematoma puncture drainage treatment through the burr hole lateral to Kocher's point from the frontal lobe in patients with hypertensive basal ganglia hemorrhage.

METHODS

Twenty-six patients were enrolled in the retrospective study. The volume of hematoma in those patients was between 25 and 35 mL, and the Glasgow Coma Scale scores were between 9 and 11; they were divided into a hematoma puncture drainage treatment group and a traditional conservative treatment group. The volume of remaining hematoma, neurological function defect scores, and life quality after treatment, duration of hospitalization, and cost of hospitalization were analyzed in these 2 groups.

RESULTS

The volume of remaining hematoma was significantly less in the drainage group than that in the traditional group on the first day and the third day after treatment (P < 0.05). Posttreatment neurological function defect scores in the drainage group were statistically lower than those in the traditional group (P < 0.05). The duration of hospitalization was significantly shorter and the cost of hospitalization was also significantly less in the drainage group than that in the traditional group (P < 0.05). The Extended Glasgow Outcome Scale and Barthel Index scores were significantly higher in the drainage group than those in the traditional group (P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05).

CONCLUSIONS

The modified hematoma puncture drainage treatment represents an effective and safe way to treat hypertensive basal ganglia hemorrhage.

Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage

Spontaneous intracerebral hemorrhage (ICH), especially related to intraventricular hemorrhage (IVH), is the most devastating type of stroke and is associated with high mortality and morbidity. Optimal management of ICH remains one of the most controversial areas of neurosurgery and no effective treatment exists for ICH. Studies comparing conventional surgical interventions with optimal medical management failed to show significant benefit. Recent exploration of minimally invasive surgery for ICH and IVH including catheter- and mechanical-based approaches has shown great promise. Early phase clinical trials have confirmed the safety and preliminary treatment effect of minimally invasive surgery for ICH and IVH. Pending efficacy data from phase III trials dealing with diverse minimally invasive techniques are likely to shape the treatment of ICH.

Minimally Invasive Intracerebral Hemorrhage Evacuation: A review

Intracerebral hemorrhage is a leading cause of morbidity and mortality worldwide. To date, there is no specific treatment that clearly provides a benefit in functional outcome or mortality. Surgical treatment for hematoma evacuation has not yet shown clear benefit over medical management despite promising preclinical studies. Minimally invasive treatment options for hematoma evacuation are under investigation but remain in early-stage clinical trials. Robotics has the potential to improve treatment. In this paper, we review intracerebral hemorrhage pathology, currently available treatments, and potential robotic approaches to date. We also discuss the future role of robotics in stroke treatment.