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<p>Severe intraventricular hemorrhage (SIVH; Graeb score ≥ 9) presents significant therapeutic challenges, including delayed hematoma resolution, CSF pathway obstruction, brainstem compression from fourth ventricular dilation, and infection risks associated with prolonged catheterization. This study evaluates the efficacy and safety of robot-assisted stereotactic minimally invasive aspiration and irrigation (RASMIAI) without fibrinolytic therapy as an alternative to conventional interventions. A retrospective analysis of 35 consecutive SIVH patients treated between January 2024 and January 2025 compared outcomes between RASMIAI group (<i>n</i> = 16) and conventional therapies (<i>n</i> = 19: stereotactic surgery, endoscopic evacuation, or external ventricular drainage [EVD]), as the control group. Procedural metrics, hematoma clearance, CSF circulation restoration, complications, mortality, and 90-day functional outcomes (mRS, GOS) were analyzed. Baseline demographics, Graeb scores, and Glasgow Coma Scale (GCS) scores were comparable between groups (<i>p</i> &gt; 0.05). RASMIAI demonstrated superior procedural efficiency (47.2 ± 8.2 vs. 90.8 ± 51.4&#xa0;min, <i>p</i> = 0.002), with significantly higher 24-hour hematoma clearance (85.6 ± 9.6% vs. 38.4 ± 20.9%, <i>p</i> &lt; 0.001) and faster CSF pathway restoration (1.3 ± 0.48 vs. 7.9 ± 2.4 days, <i>p</i> &lt; 0.001). Postoperative imaging revealed near-complete hematoma resolution (Graeb score: 1.5 ± 0.97 vs. 6.1 ± 2.0, <i>p</i> &lt; 0.001). The RASMIAI cohort exhibited no intracranial infections (0% vs. 31.6%, <i>p</i> = 0.014) and zero mortality at 90 days (0% vs. 36.8%, <i>p</i> = 0.007). Functional outcomes favored RASMIAI, with significantly improved the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) scores (<i>p</i> &lt; 0.01). RASMIAI represents a paradigm shift in SIVH management, enabling simultaneous supratentorial and fourth ventricular hematoma evacuation without fibrinolytic agents. Its precision-driven approach reduces procedural time, enhances hematoma clearance, accelerates neurological recovery, and mitigates infection and mortality risks. These findings may indicate RASMIAI as a promising minimally invasive technique for severe IVH cases.</p>

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Robot-assisted stereotactic minimally invasive aspiration and irrigation (RASMIAI): a novel approach for severe intraventricular hemorrhage

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Wenhua Zhang,
  • Hao Guo,
  • Xiaoying Guo,
  • Conghui Li

摘要

Severe intraventricular hemorrhage (SIVH; Graeb score ≥ 9) presents significant therapeutic challenges, including delayed hematoma resolution, CSF pathway obstruction, brainstem compression from fourth ventricular dilation, and infection risks associated with prolonged catheterization. This study evaluates the efficacy and safety of robot-assisted stereotactic minimally invasive aspiration and irrigation (RASMIAI) without fibrinolytic therapy as an alternative to conventional interventions. A retrospective analysis of 35 consecutive SIVH patients treated between January 2024 and January 2025 compared outcomes between RASMIAI group (n = 16) and conventional therapies (n = 19: stereotactic surgery, endoscopic evacuation, or external ventricular drainage [EVD]), as the control group. Procedural metrics, hematoma clearance, CSF circulation restoration, complications, mortality, and 90-day functional outcomes (mRS, GOS) were analyzed. Baseline demographics, Graeb scores, and Glasgow Coma Scale (GCS) scores were comparable between groups (p > 0.05). RASMIAI demonstrated superior procedural efficiency (47.2 ± 8.2 vs. 90.8 ± 51.4 min, p = 0.002), with significantly higher 24-hour hematoma clearance (85.6 ± 9.6% vs. 38.4 ± 20.9%, p < 0.001) and faster CSF pathway restoration (1.3 ± 0.48 vs. 7.9 ± 2.4 days, p < 0.001). Postoperative imaging revealed near-complete hematoma resolution (Graeb score: 1.5 ± 0.97 vs. 6.1 ± 2.0, p < 0.001). The RASMIAI cohort exhibited no intracranial infections (0% vs. 31.6%, p = 0.014) and zero mortality at 90 days (0% vs. 36.8%, p = 0.007). Functional outcomes favored RASMIAI, with significantly improved the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) scores (p < 0.01). RASMIAI represents a paradigm shift in SIVH management, enabling simultaneous supratentorial and fourth ventricular hematoma evacuation without fibrinolytic agents. Its precision-driven approach reduces procedural time, enhances hematoma clearance, accelerates neurological recovery, and mitigates infection and mortality risks. These findings may indicate RASMIAI as a promising minimally invasive technique for severe IVH cases.