The surgical management of intracerebral hemorrhage (ICH) remains controversial. While minimally invasive endoscopic techniques have shown promise, recent trials have not demonstrated positive outcomes for deep-seated basal ganglia hemorrhages. Although we previously reported a novel robot-assisted visualized minimally invasive aspiration (RAVMIA) technique effective for oblong hematomas, irregularly shaped or massive basal ganglia hemorrhages continue to pose a significant clinical challenge. We applied a dual-port RAVMIA technique in a case of irregular basal ganglia hemorrhage. The hematoma was morphologically deconstructed into two ellipsoids. Using robotic planning, two surgical trajectories were designed along their long axes. Two 5-mm trocars were inserted along these trajectories, and a contact-visible endoscope was used for real-time monitoring of the aspiration process. The procedure was successfully completed without complications. The total brain parenchymal injury measured 1 cm (comprising two 5-mm tracts). A 92.9% hematoma evacuation rate was achieved within 25 min. Postoperatively, the patient showed improvement in neurological function. This preliminary technical report demonstrates the potential applicability of the dual-port RAVMIA technique in a single case of irregular basal ganglia hemorrhage. Further studies with larger cohorts are warranted to evaluate its safety, efficacy, and generalizability.
Li et al. (Sun,) studied this question.