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

Objective: The aim of this study was 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 HICH patients 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 effect 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, Patients undergoing neuroendoscopic had 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 ICP monitoring group (615.2±63.8 vs 547.8±65.3 ml, P<0.001) and there was a significant difference in 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 versus 3.8±0.8, p=0.011). Patients undergoing robot-assisted neuroendoscopic combined ICP monitoring had a 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 HICH patients. Conclusions：Robot-assisted neuroendoscopic hematoma evacuation combined intracranial pressure monitoring appears to be more safe and effective than neuroendoscopic hematoma evacuation in the treatment of HICH. Robot-assisted neuroendoscopic hematoma evacuation combined ICP monitoring may improve the clinical effect and treatment outcomes of HICH patients.