Neuroendoscopic surgery for brainstem hemorrhage: Technical notes and preliminary clinical results

Background

Brainstem hemorrhage accounts for a relatively small proportion of spontaneous intracerebral hemorrhages (∼10 %) but tends to occur earlier in life and has poorer prognosis. Numerous studies support the therapeutic potential of minimally invasive hematoma evacuation for intracerebral hemorrhage; however, there have been few assessments of the benefits for brainstem hemorrhage.

Methods

We evaluated the safety and efficacy of a minimally invasive approach under neuroendoscopic guidance with pneumatic arm fixation for removing the hematoma in severe brainstem hemorrhage patients. 14 patients diagnosed with primary brainstem hemorrhage and treated by neuroendoscopy-assisted evacuation at Suzhou Ninth Hospital affiliated to Soochow University were included in the study. Relevant clinical and prognostic date were collected and analyzed.

Results

Hematoma volume ranged from 8 to 13 mL according to preoperative CT, while GCS at admission ranged from 4 to 6. The average operative time was 157 min and average intraoperative blood loss was 86 mL. All patients achieved satisfactory hematoma evacuation (over 90 %) according to immediate postoperative CT. Postoperative intensive care unit stay averaged 9.5 days and respiratory support averaged 7.5 days. 11 patients required tracheotomy due to pulmonary infection and absence of pharyngeal reflexes. 9 patients achieved satisfactory functional recovery (GOS score of 4 and 3), while 5 remained in a vegetative state (GOS score of 2).

Conclusion

Neuroendoscopy provides excellent direct visualization of brainstem hematomas for safe and reliable evacuation. Patients with a new PPH score of 2 or 3 are more likely to benefit from surgical treatment. Large-scale studies are required to identify patients most likely to benefit from this technique.