NaoTrac: Changing the Guidelines of ICH

There are over 3.4 million cases of new intracerebral hemorrhages (ICHs) each year. Globally, over 28% of all new onset strokes are intracerebral hemorrhages. 

Intracerebral Hemorrhage is scored by the volume and the status of the patient’s condition. 

Generally, for patient with smaller volume of intracerebral hemorrhage, the mortality rate is lower. Therefore, most hematoma with volume less than 30ml is managed conservatively by waiting for hematoma absorption and cerebral edema regression. However, functional recovery is not necessarily related to the amount of hematoma.

Dr. Jeng-Hung, Guo is the neurosurgeon at China Medical University Hospital in Taichung, Taiwan. He has been working at the China Medical University Medical Center for more than 15 years. In this interview with Dr. Jeng-Hung, Guo, we will learn how NaoTrac changes the guidelines of ICH. His majority is,

1. Neurosurgical procedures and interventional treatment for cerebrovascular diseases (such as cerebral aneurysms) 
2. Brain tumor surgery
3. Spinal vascular diseases
4. Spinal tumor surgery
5. High cervical spinal surgery, minimally invasive spinal surgery, degenerative spinal surgery, and traumatic spinal surgery
6. Traumatic intracranial hemorrhage surgery, spontaneous intracranial hemorrhage surgery
7. Peripheral nerve surgery
8. Neurocritical care

Q: What is the rationale for using NaoTrac in performing surgery for ICH hemorrhagic stroke?

I am Dr. Jeng-Hung, Guo, the neurosurgeon at China Medical University Hospital in Taichung, Taiwan. Our hospital is equipped with NaoTrac, the surgical navigation robot, from Brain Navi Biotechnology. Originally, it was used for brain tumor biopsy and neuro-endoscopic surgery. Recently, we performed a case of brainstem (prone) hemorrhage and intraventricular hemorrhage (IVH) with acute hydrocephalus. The patient’s family was anxious and eager to save the father of the family. The vital sign of the patient was quite stable, but he remains semi-coma status. The surgical pathway from scalp to the brainstem was around 11.8cm, which 

made me hesitate with the traditional navigation system. After discussion with the head of the Department of Neurosurgery of China Medical University Hospital, we performed the brainstem hematoma aspiration on the 10^th day with the NaoTrac. The result of the surgeries went well and we planned to perform more hemorrhagic stroke with hematoma less than 30ml. 

Q: How can minimally invasive surgery be performed for intracerebral hemorrhagic stroke with a blood clot volume of less than 30ml?

For hematomas larger than 30ml, surgery is usually performed promptly due to the high mortality rate. Conversely, for hematoma less than 30ml, conservative treatment is often suggested because the mortality rate is lower. However, functional recovery often diminishes over time and the golden recovery period usually ends in 6 months. The advantages of NaoTrac are high-speed registration with high accuracy and minimal invasiveness. I deeply believe that the neurosurgeon will have better and safer ways to treat patients with hemorrhagic stroke. 

For patients who used to rely on self-absorption of the hematoma and waiting the diminish of the peri-hematoma edema with time, there is another treatment to remove the hematoma, reduce the mass effect of the hematoma on neural pathways, and decrease the inflammation response, leading to significant and faster improvement. A faster and intuitive surgery can directly change a patient’s outcome for decades to come.

Q: What benefits have you seen from performing robotic surgery with NaoTrac for ICH hemorrhagic stroke compared to traditional methods?

Fast in patient registration: Unlike the traditional navigation technology, NaoTrac uses machine vision for patient registration. The total surgical time is usually completed in 1.5 hours and patient registration in less than 3 minutes.

We have performed more than six cases and here is the figure chart information: 

China Medical University Hospital

High precision in neurosurgical navigation: The clearance rate of the hematoma depends on lots of factors. The goal of hematoma clearance is at least 75%, reaching a better outcome. In our cases, the clearance rate can reach 95%. With NaoTrac, the surgical instruments can be precisely guided to the targeted lesion, making it easier to remove the hematoma.

Surgical Tool Registration: The machine vision technology of NaoTrac allows neurosurgeons to use their own surgical instruments, eliminating the need to learn a new navigation system. Tool registration only takes seconds to complete.

User-Friendly Interface: Having used NaoTrac since October 2022, I found it easy to learn how to use because of its user-friendly interface by following the green guide on the screen. Shortening the learning curve for new technologies is a real and actual benefit to neurosurgeons.

Q: How is the clinical case that using NaoTrac in performing surgery for intracerebral hemorrhagic stroke with the hematoma less than 30ml? How is the recovery?

According to the ICH guideline, hematoma less than 30ml is usually suggested of self-absorption and undergoing a long-term rehabilitation period. However, there is still a high risk of functional non-recovery. I would suggest waiting at least 3 days for the hematoma to liquefy, facilitating hematoma aspiration with NaoTrac.

Q: After reviewing these clinical cases, would you recommend that other neurosurgeons adopt NaoTrac for performing neurosurgery? What kind of impact do you think this technology could have on the neurosurgery field?

I would definitely recommend NaoTrac to other neurosurgeons. After using it for ICH procedures, I believe that NaoTrac has several alternative applications that can be used in the field of neurosurgery. Calling NaoTrac an “enabler” provides different opportunities in the operating room. It can assist not only with brain tumor biopsies or ablations, but also with radiation therapy, stem cell implantation, and more. NaoTrac has the potential to be a revolutionary surgical navigation robot in this era.