Abstract
BACKGROUND: A structured-light robotic system enables noninvasive surface-based facial registration for patient-to-image alignment; however, it has not been widely adopted for basal ganglia hematoma treatment. This study evaluates its safety, accuracy, and efficiency in patients with basal ganglia hematomas. METHODS: Retrospective consecutive patients with spontaneous basal ganglia hematomas (10-30 mL) admitted from January 2022 to January 2024 were grouped as surgical or non-surgical. Outcomes were analyzed, focusing on registration accuracy and surgical efficiency. RESULTS: Baseline preoperative hematoma volume, GCS, NIHSS, and coagulation disorders were comparable between groups (p > 0.05). Mean registration time was 120 ± 56 s and surgery time 102.22 ± 6.33 min; hematoma clearance was 72% initially and 93% at 7 days. Entry-point discrepancy was 2.2 ± 0.7 mm; catheter tip alignment in the upper/middle/lower hematoma segments was 4%/80%/16%, with a maximum 5.7-mm deviation from the midline axis. The surgery group showed faster recovery with higher 24 h-GCS (p < 0.001) and better NIHSS/ADL/mRS than non-surgery (p < 0.001 at all time points; p = 0.003 and p = 0.026 at 30 and 90 days; p = 0.041). At 90 days, facial palsy, sensory loss, and ulcers were similar (p > 0.05), whereas pneumonia (p = 0.034) and UTIs (p = 0.002) were lower in the surgery group. No mortality, bleeding, or reoperations occurred. CONCLUSIONS: Surface registration using the 3D structured light technique is a fast and precise alternative treatment for selected patients with spontaneous medium-volume basal ganglia hematomas, which can improve clinical efficiency while maintaining sufficient accuracy and safety to meet clinical requirements. TRIAL REGISTRATION: retrospectively registered with approval by the Ethics Committee of Shanghai Fourth people's hospital, Tongji University School of Medicine (No. 2022327-001).