Abstract
Background: Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage. Case Presentation: A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. Conclusion: CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.
Highlights
Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management
Case Presentation: A 53-year-old man who was diagnosed with brainstem pontine hemorrhage
Computed tomography (CT)-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy
Summary
Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. Conclusion: CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy. A 55-year-old male was admitted to our hospital on September 29, 2019, due to the sudden onset of a coma of 2 h duration He had a history of hypertension but was non-compliant with taking his medication for this condition. The patient’s pupils were unresponsive to light and had diameters of 1 mm and 2 mm for the right and left eyes, respectively His vital signs were as follows: heart rate of 110 beats/min, blood pressure of 175/100 mmHg, respiratory rate of 16 breaths/min, and a temperature of 38.5 ̊C. Computed tomography (CT) on the day of admission showed a brainstem pontine hemorrhage (Figure 1(a)) He was treated with mechanical ventilation, conservative medical management
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