Efficacy and safety of The Robotic Stereotactic Assistance for intracerebral hemorrhage; A systematic review and meta-analysis

Intracerebral hemorrhage (ICH) is a critical medical condition associated with a high mortality rate. Surgical evacuation of extensive hemorrhage can improve survival and functional outcomes, but deep brain location poses a challenge. Our study seeks to provide robust evidence highlighting the efficacy, safety, and contribution of Robotic Stereotactic Assistance (ROSA) in advancing neurosurgical practices in the evacuation of ICH compared to conventional treatment methods. We searched for relevant papers comparing ROSA with conventional treatments until October 2024, using four electronic databases: PubMed, Scopus, the Cochrane Library, and Web of Science. The analysis was done using R Software. Continuous data was pooled as mean difference (MD), and dichotomous data was pooled as odds ratio (OR) in a random effect model with a relative 95% CI. A sub-group analysis was conducted according to the type of conventional therapy and the site of the hemorrhage. Eleven studies, comprising 968 patients (478 in the ROSA group and 490 in the control group "non-ROSA"), were included in the systematic review and meta-analysis. The analysis of primary outcomes revealed significantly higher postoperative Glasgow Coma Scale (GCS) scores, MD of 1.80 (95% CI: 0.68 to 2.92; p < 0.01), and lower rebleeding rates, OR of 0.26 (95% CI: 0.10 to 0.66; p < 0.01). However, no significant difference in mortality was found between the two groups, with an OR of 0.38 (95% CI: 0.11 to 1.38; p = 0.14). Regarding secondary outcomes, the ROSA group significantly reduced surgery duration and decreased intracranial infections and pneumonia. No significant difference was observed between the groups concerning central hypothermia. Using the ROSA robotic system for ICH evacuation is associated with improved neurological outcomes. These findings highlight the potential benefits of ROSA in advancing neurological practices for the management of ICH.