Micro/nanodevice-loaded minimally invasive robot for hematoma evacuation: A novel technology for primary brainstem hemorrhage treatment

The brainstem, often referred to as the 'vital center of life,' controls functions such as breathing, heartbeat, consciousness, and sensory and motor functions. It is densely packed with structures responsible for critical physiological functions; thus, even a minimal hemorrhage in the brainstem can be life-threatening. Primary brainstem hemorrhage (PBSH) accounts for approximately 6%–10% of all intracerebral hemorrhages and represents the most fatal subtype, with mortality rates as high as 80% in cases of massive bleeding.1 Owing to the unique structure and function of the brainstem, treatment and rescue efforts for PBSH need to be both timely and appropriate. Given the substantial risks associated with craniotomy surgery, conservative treatment is commonly administered in clinical settings despite its limited efficacy. Reducing the mortality and disability rates associated with PBSH remains a major challenge in clinical settings worldwide. However, owing to newfound knowledge of points of safe access to the brainstem region and the development of new technologies and devices in areas such as neuroimaging, microsurgery, neuro-navigation, and neurorehabilitation, surgical intervention is a suitable option for managing PBSH. The findings of the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE III) trial confirmed the efficacy of minimally invasive surgery (MIS) in reducing the rate of all-cause mortality of patients with supratentorial intracerebral hemorrhage,2 suggesting that MIS combined with thrombolysis is a more promising option for treating PBSH than what currently exists. Robot-assisted MIS is notable for its distinctive safety characteristics and potential for successful hematoma clearance. Within this context, rapid and accurate localization of the bleeding area, determination of the optimal puncture path, and thorough removal of the hematoma while minimizing damage to vital anatomical structures in the brainstem are critical aspects of treatment. To address this issue, we propose a micro/nanodevice-loaded minimally invasive robot for hematoma evacuation.