ABSTRACT NUMBER: ESOC2026A603 ROBOT-ASSISTED STEREOTACTIC SURGERY FOR INTRACEREBRAL HEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF SAFETY AND EFFICACY

Abstract Background and aims Intracerebral hemorrhage (ICH) carries a high risk of poor neurological outcomes. Although surgical evacuation can be beneficial, deep-seated hematomas limit the effectiveness of conventional approaches. Robotic stereotactic assistance has been introduced to enhance precision during hematoma evacuation. This study evaluates the clinical impact of Robotic Stereotactic Assistance (ROSA) compared with standard surgical management of ICH. Methods A systematic review and meta-analysis of comparative studies was conducted using PubMed, Scopus, the Cochrane Library, and Web of Science up to October 2024. Outcomes were synthesized using random-effects models. Neurological outcomes, perioperative variables, and postoperative complications were assessed. Subgroup analyses were performed based on hemorrhage location and type of conventional surgical technique. Results Eleven studies, including 968 patients, were analyzed. ROSA-assisted evacuation was associated with improved early postoperative neurological status, with Glasgow Coma Scale scores nearly two points higher than conventional approaches (mean difference approximately 1.8; 95% CI ~0.7–2.9). The risk of rebleeding was substantially reduced, with odds approximately one quarter of those observed in non-robotic procedures (OR ~ 0.26; 95% CI ~ 0.10–0.66). ROSA use was also linked to shorter operative duration and lower rates of selected postoperative complications, including infectious events. No statistically significant difference in overall mortality was observed between groups. Conclusions ROSA-guided evacuation of intracerebral hemorrhage is associated with improved neurological recovery and reduced rebleeding risk compared with conventional surgical techniques, without evidence of increased mortality. These findings support the growing role of robotic assistance in the surgical management of ICH. Conflict of interest Nada Mostafa Al-dardery: nothing to disclose. Mohamed Diaa Elfakhrany: nothing to disclose. Mohamed El-Samahy: nothing to disclose. Shahd Alqato: nothing to disclose. Suhel F. Batarseh: nothing to disclose. Ahmed Taha Abdelsattar: nothing to disclose. Mohamed Abouzid: nothing to disclose.