Combined Robotic Stereotactic Assistance (ROSA) with intraoperative mobile CT for intracerebral hemorrhage aspiration: technical note and case series

Objectives: This study aims to present a novel technique combining robotic stereotactic assistance (ROSA) with intraoperative mobile CT (AIRO CT) for the aspiration of spontaneous intracerebral hemorrhage (ICH). Methods: We present a case series of cases combining ROSA and AIRO CT for hematoma aspiration, with detailed procedural descriptions in basal ganglia and lobar ICH patients treated between 2024 and 2025. Results: Twenty patients achieved satisfactory hematoma clearance confirmed by intraoperative AIRO CT. Two patients attained favorable neurological outcomes (modified Rankin Scale≤ 2), and four demonstrated intermediate recovery (mRS = 3), indicating partial functional improvement. One patient expired within 30 days due to non-neurological causes. Conclusions: Our integrated technique combining ROSA and AIRO CT provides a feasible and practical approach for minimally invasive ICH evacuation. This method enhances hematoma clearance, improves intraoperative confidence, and increases overall surgical safety.