Zhang Wenhua, Guo Hao, Guo Xiaoying, Li Conghui
Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Neurosurg Rev. 2025 Oct 30;48(1):747. doi: 10.1007/s10143-025-03867-6.
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.
重度脑室内出血（SIVH；格雷布评分≥9分）带来了重大的治疗挑战，包括血肿吸收延迟、脑脊液通路阻塞、第四脑室扩张导致的脑干受压以及与长期置管相关的感染风险。本研究评估了不使用纤溶治疗的机器人辅助立体定向微创抽吸和冲洗术（RASMIAI）作为传统干预措施替代方案的有效性和安全性。对2024年1月至2025年1月期间连续治疗的35例SIVH患者进行回顾性分析，比较了RASMIAI组（n = 16）和作为对照组的传统治疗组（n = 19：立体定向手术、内镜下血肿清除或脑室外引流[EVD]）的治疗结果。分析了手术指标、血肿清除情况、脑脊液循环恢复情况、并发症、死亡率以及90天功能结局（改良Rankin量表[mRS]、格拉斯哥预后量表[GOS]）。两组间的基线人口统计学数据、格雷布评分和格拉斯哥昏迷量表（GCS）评分具有可比性（p > 0.05）。RASMIAI显示出更高的手术效率（47.2±8.2分钟对90.8±51.4分钟，p = 0.002），24小时血肿清除率显著更高（85.6±9.6%对38.4±20.9%，p < 0.001），脑脊液通路恢复更快（1.3±0.48天对7.9±2.4天，p < 0.001）。术后影像学检查显示血肿几乎完全吸收（格雷布评分：1.5±0.97对6.1±2.0，p < 0.001）。RASMIAI队列未出现颅内感染（0%对31.6%，p = 0.014），90天时死亡率为零（0%对36.8%，p = 0.007）。功能结局有利于RASMIAI，改良Rankin量表（mRS）和格拉斯哥预后量表（GOS）评分显著改善（p < 0.01）。RASMIAI代表了SIVH治疗模式的转变，能够在不使用纤溶药物的情况下同时清除幕上和第四脑室血肿。其精确驱动的方法减少了手术时间，提高了血肿清除率，加速了神经功能恢复，并降低了感染和死亡风险。这些发现可能表明RASMIAI是一种用于严重IVH病例的有前景的微创技术。
