In our study comparing robot assisted puncture and conservative treatment for severe brainstem hemorrhage, we found that the former has significant advantages in patient prognosis. Brain stem hemorrhage is a devastating disease with a high mortality rate [11], especially when the hematoma size exceeds 5 milliliters [12,13,14]. The grouping of conservative treatment and robot assisted surgery in this study was not due to differences in hematoma volume, but rather because conservative treatment was chosen due to family members’ refusal. For patients with severe brainstem hemorrhage, conservative treatment often fails to timely and adequately relieve the compression of the hematoma on the brainstem and the secondary neurological damage. Robot hematoma puncture can significantly reduce the remaining amount of hematoma, and there is a significant difference between the two groups of patients (p < 0.001) [14, 15].

At present, although stereotactic surgery can improve the neurological function of some patients, the improvement of neurological function in most patients cannot reach the level that allows patients to live and work independently. Compared with conservative treatment, there is no significant difference in mRS scores in group of robot assisted puncture (p > 0.05), which is considered to be related to severe primary damage [12, 16]. In addition, the initial GCS score of the robot assisted therapy group was worse than that of the conservative treatment group [13, 15, 17].

In contrast, robot assisted puncture and drainage surgery provides a more effective solution. Advanced imaging technology and robotic systems promote precise targeting, ensuring the accuracy of interventions, minimizing volume of hemmorahge, and protecting brainstem function. Our research findings indicate that compared to conservative treatment [14, 18], robot assisted surgery significantly reduced mortality rates [10, 14, 15], which is consistent with previous research results, possibly due to its timeliness, accuracy, and minimally invasive nature [15, 19].

A key consideration for any surgical intervention, especially in fragile brainstem areas, is to reduce surgical risks and prevent complications. Preoperative planning and intraoperative monitoring play a crucial role in further reducing these risks. However, it is important to acknowledge that no surgical technique can completely eliminate all risks [5, 6, 12, 19, 20]. Due to the non-invasive nature of conservative treatment, the incidence of intracranial infections is lower in the conservative group compared to the robot assisted puncture group. However, due to the early relief of hematoma compression, the overall incidence of complications in the robot assisted puncture group is much lower than that in the conservative group.

In terms of the treatment of intracranial infections, compared with the conservative treatment group, patients in the robotic puncture drainage group had a significantly increased risk of infection due to the invasive operation involved in this treatment method, with an infection rate increased to 14.3%. However, there were no infection cases in the conservative treatment group (14.3% vs. 0%, p = 0.001). Due to the problem of pneumonia caused by long-term bed rest, both groups maintained a high incidence of pulmonary infection, making it difficult to effectively reduce it.

There is a statistical difference in the incidence of epilepsy between the two groups. This may be due to the fact that during the process of robot puncture drainage, the drainage pipeline may cause certain damage to nerve cells, and some damaged nerve cells may subsequently produce abnormal discharges, thereby increasing the risk of epileptic seizures. Therefore, the incidence of epilepsy in patients in the robot puncture drainage group was relatively high. Studies have shown that patients with stroke or intracranial hemorrhage, particularly those experiencing late-stage seizures, exhibit a significantly higher mortality rate [21, 22]. Our research further verifies this finding, indicating that none of the patients who developed late-stage seizures following brainstem hemorrhage survived the 60-day follow-up period.

Meanwhile, there was a statistically significant difference (p < 0.05) in central hyperthermia between the two groups. However, there was no statistically significant difference in the incidence of other complications such as stress ulcers, rebleeding, and deep vein thrombosis in the lower lim

The clinical manifestations of brainstem hemorrhage are complex and diverse, including consciousness disorders, respiratory disorders, etc. The timing and severity of these symptoms are closely related to the amount and location of bleeding, also affect the duration and cost of hospitalization [12, 15, 17]. Our retrospective study found significant differences in hospitalization costs and duration between the conservative group and the robot assisted group.The average hospitalization time for the robot group is 21 days, which is relatively longer compared to the conservative group’s 15 days. This difference may be attributed to some patients in the conservative group who unfortunately passed away shortly after admission, resulting in a shorter hospital stay and thus lowering the average length of hospital stay in this group. In terms of average hospitalization costs, the robot group was as high as 105,231 yuan, significantly exceeding the conservative group’s 55221.5 yuan. In order to ensure that the patient does not have any complications after surgery, it is necessary to closely monitor for a longer period of time in the neurological intensive care unit, which also increases the hospitalization costs accordingly [23]. In the realm of medical decision-making, securing optimal treatment outcomes and facilitating prognosis recovery for patients suffering from critical and severe brainstem hemorrhages holds a paramount and indispensable position. While the financial expenditure associated with such treatments may be substantial, these investments prove exceptionally justified and vital when they lead to significant improvements in patient’s quality of life, an extension of their lifespan, and a marked decrease in the necessity for subsequent treatments and the risks of complications. Upon thorough cost-effectiveness analysis, we are firmly convinced that incurring higher clinical costs is unequivocally worthwhile in pursuing superior clinical outcomes for patients with brainstem hemorrhages.