Effect of Robot-Assisted Neuroendoscopic Hematoma Evacuation Combined Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage.

Shiqiang Wu,Kai Shu,Ting Lei,Junwen Wang,Wei Jiang,Feng Hu,Heping Wang

doi:10.3389/fneur.2021.722924

Abstract

Objective: This study aimed to investigate the clinical efficacy of robot-assisted neuroendoscopic hematoma evacuation combined intracranial pressure (ICP) monitoring for the treatment of hypertensive intracerebral hemorrhage (HICH).Patients and Methods: A retrospective analysis of 53 patients with HICH undergoing neuroendoscopic hematoma evacuation in our department from January 2016 to December 2020 was performed. We divided the patients into two groups: the neuroendoscopic group (n = 32) and the robot-assisted neuroendoscopic combined ICP monitoring group (n = 21). Data on clinical characteristics, treatment effects, and outcomes were retrospectively reviewed and analyzed between these two groups.Results: The operation time of the procedure of the neuroendoscopic group was significantly longer than that of the robot-assisted neuroendoscopic combined ICP-monitoring group (mean time 153.8 ± 16.8 vs. 132.8 ± 15.7 min, P < 0.001). The intraoperative blood loss was significantly less in the robot-assisted neuroendoscopic combined ICP-monitoring group than in the neuroendoscopic group (215.4 ± 28.3 vs. 190.1 ± 25.6 ml, P = 0.001). However, the patients undergoing neuroendoscopic had a comparable hematoma clearance rate with those undergoing robot-assisted neuroendoscopic combined ICP monitoring (85.2 ± 4.8 vs. 89.2 ± 5.4%, P = 0.997). The complications rate was greater in the endoscopic group (25%) than in the robot-assisted neuroendoscopic combined ICP-monitoring group (9.5%) but without significant difference (P = 0.159). We also found that the dose of used mannitol was significantly less in the ICP monitoring group (615.2 ± 63.8 vs. 547.8 ± 65.3 ml, P < 0.001) and there was a significant difference in modified Rankin scale (mRS) score at discharge, patients with less mRS score in the robot-assisted neuroendoscopic combined ICP monitoring group than in the neuroendoscopic group (3.0 ± 1.0 vs. 3.8 ± 0.8, p = 0.011). Patients undergoing robot-assisted neuroendoscopic combined ICP monitoring had better 6-month functional outcomes, and there was a significant difference between the two groups (p = 0.004). Besides, multivariable analysis shows younger age, no complication, and robot-assisted neuroendoscopic combined ICP monitoring were predictors of 6-month favorable outcomes for the patients with HICH.Conclusion: Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring appears to be safer and more effective as compared to the neuroendoscopic hematoma evacuation in the treatment of HICH. Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring might improve the clinical effect and treatment outcomes of the patients with HICH.

Highlights

Hypertensive intracerebral hemorrhage (HICH) is a common serious cerebrovascular disease with high mortality and morbidity rate, which frequently occurs in the middle-aged and elderly population, with a peak incidence in winter and spring [1,2,3]
We retrospectively reviewed 53 patients with HICH undergoing neuroendoscopic hematoma evacuation in the Tongji Hospital, the purpose of this study was to investigate the clinical efficacy of robot-assisted neuroendoscopic hematoma evacuation and intracranial pressure (ICP) monitoring for the treatment of HICH
There were no significant differences in patient age, sex, the Glasgow Coma Scale (GCS) score, systolic pressure admission, the National Institutes of Health Stroke Scale (NIHSS) score, localization of hematoma, hematoma volume, or midline shift between the neuroendoscopic group, and the robot-assisted neuroendoscopic hematoma evacuation combined ICP monitoring group

Summary

Introduction

Hypertensive intracerebral hemorrhage (HICH) is a common serious cerebrovascular disease with high mortality and morbidity rate, which frequently occurs in the middle-aged and elderly population, with a peak incidence in winter and spring [1,2,3]. The surgical methods mainly include conventional craniotomy, small-bone window craniotomy, stereotactic aspiration, neuroendoscopic hematoma evacuation, and so on [6, 7]. Neuroendoscopic hematoma evacuation has been applied widely in the treatment of patients with HICH, which is less invasive than craniotomy and can achieve hemostasis of the bleeding vessels [8, 9]. Neuroendoscopic hematoma evacuation has its inherent shortcomings such as a narrow surgical window results in a low-removal rate, sometimes cannot reach the designated position accurately and rapidly, and should be performed by a skilled surgeon. Neuro-navigation and robotic technologies have been developed and used in surgical procedures to reduce brain injury and improve clinical outcomes and prognosis of patients with HICH [11]

Methods

Results

Discussion

Conclusion