# Efficacy of 3D slicer-assisted minimally invasive thrombolysis combined with soft channel drainage versus craniotomy: a retrospective study in moderate basal ganglia hemorrhage

## TL;DR

This study compares a minimally invasive brain surgery technique with traditional craniotomy for moderate basal ganglia hemorrhage, finding the new method to be safer, faster, and more cost-effective.

## Contribution

The study introduces and evaluates the clinical efficacy of 3D Slicer-assisted minimally invasive thrombolysis with soft channel drainage for moderate basal ganglia hemorrhage.

## Key findings

- The minimally invasive group had less blood loss, shorter operative time, and fewer complications compared to the craniotomy group.
- Patients in the minimally invasive group showed better functional recovery and lower healthcare costs at 6 months post-surgery.
- The minimally invasive technique demonstrated a more favorable incremental cost-effectiveness ratio.

## Abstract

The optimal clinical treatment strategy for moderate basal ganglia hemorrhage (30–50 mL) remains a subject of debate. This study aims to evaluate the clinical efficacy of 3D Slicer-assisted minimally invasive thrombolysis combined with soft channel drainage by comparing it with traditional craniotomy, thus assessing the clinical value of this minimally invasive approach.

In this retrospective study, the patients were divided into the minimally invasive group and the craniotomy group based on surgical approaches. The study compared operative time, hematoma clearance rates, and postoperative complication rates between the two groups. Functional recovery was assessed at 6 months postoperatively using the modified Rankin Scale (mRS) and Barthel Index. Additionally, the study analyzed differences in medical costs and cost-effectiveness between the two treatment approaches.

A total of 112 patients were enrolled, with 41 in the minimally invasive group and 71 in the craniotomy group. Baseline characteristics showed no significant differences between groups (all p > 0.05), including demographics [e.g., sex: 30 males (73.2%) and 11 females (26.8%) vs. 51 males (71.8%) and 20 females (28.2%)], median age: [70 (63.5–76.5) years vs. 65 (58–72) years], median hematoma volume: [40.6 (37.7–47.8) mL vs. 41.2 (35.4–45.1) mL], median GCS score: [9 (8–11) vs. 10 (9–11)], median NIHSS score: [15 (11.5–18) vs. 12 (10–18)], median midline shift [3.70 (2.85–5.10) mm vs. 4.20 (3.20–5.70) mm], and proportion of intraventricular hemorrhage [6 (14.6%) vs. 14 (19.7%)]. Hematoma location and underlying diseases were also comparable. Compared to the craniotomy group, the minimally invasive group exhibited significantly less intraoperative blood loss, shorter operative time, lower rates of tracheostomy and pulmonary infection (p < 0.05), and smaller volume of cerebral edema at 72 h postoperatively (p < 0.05). Follow-up results 6 months postoperatively indicated that the minimally invasive group had significantly lower mRS scores and higher Barthel Index scores (p < 0.05). Regarding healthcare costs, expenses were lower in the minimally invasive group, and the incremental cost-effectiveness ratio (ICER) was more favorable (p < 0.05).

3D Slicer-assisted minimally invasive thrombolysis combined with soft channel drainage represents an effective treatment for patients with moderate basal ganglia hemorrhage. It offers several advantages, including precise localization, minimal surgical trauma, a low complication rate, favorable safety profile, and cost-effectiveness. Therefore, this minimally invasive technique holds significant clinical value.