Surgical Treatment for Primary Brainstem Hemorrhage to Improve Postoperative Functional Outcomes

World Neurosurgery
Shinya IchimuraKoji Fujii

Abstract

It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly by surgical evacuation of the hematoma. In the present study, we discuss 5 cases of PBH that were treated surgically and the ability of surgical management to improve postoperative functional outcomes. The 4 patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and trans-rhomboid fossa approach in the half-sitting position. The patient with a midbrain hemorrhage underwent surgery via the subtemporal approach in the supine lateral position. We analyzed the postoperative functional outcomes 1 week after surgery and the modified Rankin scale scores 6 months after discharge. Three patients with disturbance of consciousness experienced improvement in their level of consciousness. Four patients with hemiparesis improved in motor function. Oculomotor nerve function improved in 2 of 3 cases. Facial nerve function improved in 2 of 2 cases. Spontaneous respiration improved in 1 patient. The postoperative modified Rankin scale scores improved in all 5 cases. Because of the good results with these 5 patients with PBH, this surgical strategy could be encouraged with exclu...Continue Reading

Citations

Jun 14, 2021·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Yan LiCong-Hui Li
Jul 16, 2021·The Tohoku Journal of Experimental Medicine·Shinjitsu NishimuraKazuo Watanabe

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