The management of spontaneous intracerebral hemorrhage(ICH) is a topic of debate. While craniotomy has been the traditional treatment, minimally invasive techniques like robot-guided stereotactic catheter drainage with urokinase(MISCD-UK) have emerged as alternatives. This study compares MISCD-UK with conventional craniotomy hematoma evacuation(CHE).

A retrospective review of 60 ICH patients treated at Xuanwu Hospital(2023–2025) was conducted, with 30 patients undergoing MISCD-UK and 30 undergoing CHE. Primary outcomes included operative metrics, complications, and 3-month functional outcomes(modified Rankin Scale [mRS], Barthel Index [BI]).

MISCD-UK significantly reduced operative duration(58 vs. 257.5 min, P < 0.001) and blood loss (5 mL vs. 225 mL, P < 0.001). ICU and hospital stays were shorter with MISCD-UK (ICU: 8 vs. 16.5 days, P = 0.005; total hospital stay: 9.5 vs. 17 days, P = 0.012). However, 3-month functional outcomes were similar (mRS 0–3: 36.7 % MISCD-UK vs. 50 % CHE, P = 0.297). Multivariable analysis showed that admission GCS, intraventricular hemorrhage, and anticoagulant use were key predictors of outcomes, while the surgical approach didn’t impact functional recovery.

MISCD-UK provides perioperative advantages over craniotomy but doesn’t improve 3-month functional outcomes, suggesting early neurologic severity and hemorrhage characteristics are crucial for prognosis.