A Multicenter, RAndomIzed, coNtrolled, umBrella Trial fOr Minimally Invasive Neurosurgery With AI-assisted Robotic guidanCe for Hemorrhagic Stroke

Description

The purpose of this clinical trial is to observe the improvements in clinical symptoms and imaging outcomes for brainstem hemorrhage using robot-assisted stereotactic puncture, evaluate the clinical efficacy and safety of this treatment, and explore the development of a high-precision, intelligent, and individualized microsurgical diagnosis and treatment process for brainstem hemorrhage. The main questions it aims to address are: * Establish a multi-center clinical database for brainstem hemorrhage. * Clinically observe and evaluate the intervention effects of robot-assisted stereotactic puncture on brainstem hemorrhage, compare it with the traditional conservative treatment control group, and investigate its efficacy and impact on patient survival, motor evoked potentials, and the degree of neurological deficits. * Optimize the Artificial Intelligence (AI) algorithm-based robotic surgical assistance system, and explore the prediction of preoperative brainstem hematoma stability and hematoma path planning. Participants in the experimental group will: * Undergo robot-assisted stereotactic minimally invasive surgery for brainstem hematoma puncture * Receive conservative non-surgical treatment. If there is a control group: the researchers will compare the conservative non-surgical treatment group to evaluate the effectiveness of robot-assisted stereotactic minimally invasive surgery for brainstem hematoma puncture.

Interventions

• Robot-assisted minimally invasive puncture and aspiration surgery (Procedure)
  Positioning and surgical operation will be performed according to the robot navigation system protocols. Preoperative imaging data will be used for precise surgical planning, including the construction of a three-dimensional (3D) preoperative visualization model. The 3D reconstruction and CT data will be imported into the AI robot-assisted stereotactic system, which, after mapping to the patient's skull, automatically designs the surgical target, calculates coordinate values, plans the puncture trajectory, and determines the cranial entry point. Different surgical approaches will be selected based on the location and shape of the hematoma, and individualized parameters, including puncture direction and trajectory length, will be generated for each patient. During the procedure, the robot will assist with stereotactic puncture, while the patient's heart rate and blood pressure are closely monitored.
• Standard medical management (Other)
  According to the "Chinese Neurosurgical Expert Consensus on the Diagnosis and Treatment of Primary Brainstem Hemorrhage", conventional medical treatment includes oxygen therapy, specialized nursing care, blood pressure control (maintaining BP at ≤140/90 mmHg), sedation, intracranial pressure reduction, arousal promotion, gastric protection, maintenance of internal homeostasis, infection prevention, neuro-nutrition, brain function support, nutritional support, and overall systemic management; For comatose patients, ensure a patent airway, provide nebulization and sputum clearance, prevent respiratory depression, and improve respiratory function. Closely monitor the patient's condition and provide active symptomatic treatment as needed. Regular cranial CT scans are performed to evaluate intracranial status, and in cases of ventricular hemorrhage or obstructive hydrocephalus, lateral ventricular puncture and drainage may be performed.

Eligibility criteria

Conditions

Locations

• China-Japan Friendship Hospital — Beijing, Beijing Municipality, China
• Aerospace Center Hospital — Beijing, Beijing Municipality, China
• The First Affiliated Hospital of Guangxi Medical University — Nanning, Guangxi, China
• Hebei Provincial People's Hospital — Shijiazhuang, Hebei, China
• Nanjing Drum Tower Hospital — Nanjing, Jiangsu, China
• Affiliated Hospital of Nantong University — Nantong, Jiangsu, China
• The Second Affiliated Hospital of Nanchang University — Nanchang, Jiangxi, China
• Huashan Hospital Fudan University — Shanghai, Shanghai Municipality, China
• Shanghai East Hospital, Tongji University — Shanghai, Shanghai Municipality, China
• Shanghai Minhang District Central Hospital — Shanghai, Shanghai Municipality, China
• Jinshan Hospital, Fudan University — Shanghai, Shanghai Municipality, China
• Tianjin Huanhu Hospital — Tianjin, Tianjin Municipality, China
• The Second Affiliated Hospital of Zhejiang University School of Medicine — Hangzhou, Zhejiang, China
• Jinhua Municipal Central Hospital / Jinhua Hospital Affiliated to Zhejiang University School of Medicine — Jinhua, Zhejiang, China
• The First Affiliated Hospital of Wenzhou Medical University — Wenzhou, Zhejiang, China