A comparison between robot-assisted minimally invasive surgery and conventional craniotomy for intracerebral hemorrhage: efficiency, complications and outcomes

Intracerebral hemorrhage (ICH) is a severe neurological condition with high morbidity and mortality rates. Robot-Assisted Minimally Invasive Surgery (RA-MIS) has emerged as a novel technique that may offer advantages over traditional craniotomy. This study aims to evaluate the clinical efficacy of RA-MIS compared to conventional craniotomy in patients with ICH.

A retrospective cohort study was conducted involving 44 patients with ICH admitted to two medical centers between December 1, 2022, and October 31, 2024. Patients were divided into two groups: 24 underwent RA-MIS, and 20 underwent traditional craniotomy. Baseline characteristics, functional outcomes [modified Rankin Scale (mRS)], neurological deficits [National Institutes of Health Stroke Scale (NIHSS)], postoperative complications, hospitalization costs, duration of respiratory support, and mortality rates were analyzed.

The RA-MIS group demonstrated significantly better functional outcomes at 90 days postoperative, with a mean mRS score of 2.58 ± 1.72 compared to 3.85 ± 1.63 in the craniotomy group (P = 0.017). NIHSS scores at 90 days were also significantly lower in the RA-MIS group (3.64 ± 3.32 vs. 7.71 ± 5.35; P = 0.006), indicating improved neurological recovery. RA-MIS patients experienced fewer postoperative complications, including lower incidences of pneumonia (16.7% vs. 70.0%; P < 0.001) and intracranial infections (0.0% vs. 20.0%; P = 0.036). The total hospitalization costs were significantly lower for the RA-MIS group (¥78,677 ± 38,904 vs. ¥136,399 ± 85,916; P = 0.006), and the duration of respiratory support was shorter (64.00 ± 161.79 h vs. 238.25 ± 197.04 h; P = 0.002). The mortality rate was significantly lower in the RA-MIS group (8.3% vs. 30.0%; P = 0.020).

RA-MIS is associated with improved functional and neurological outcomes, fewer postoperative complications, reduced hospitalization costs, and lower mortality rates compared to traditional craniotomy in patients with ICH. These findings suggest that RA-MIS may be a more effective and economical surgical option for hematoma evacuation in ICH patients.