Abstract
Among spontaneous intracranial haemorrhages, primary non-traumatic brainstem haemorrhages are associated with the highest mortality rate. Patients classically present with rapid neurological deterioration. Previous studies have found that the severity of initial neurological symptoms and hydrocephalus are predictors of poor outcomes. In addition, radiological parameters aim to classify brainstem haematomas according to volume, extension and impact on prognosis. However, previous studies have failed to agree on a differentiated radiological classification for outcome and functional recovery. Electrophysiology, including motor, auditory and somatosensory evoked potentials, is used to estimate the extent of the initial injury and predict functional recovery. The current management of brainstem haematomas remains conservative, focusing on initial close neurocritical care monitoring. Surgical treatment concepts exist, but similarly to general intracranial haemorrhage management, they continue to be controversial and have not been sufficiently investigated. This is especially the case for haematomas in the posterior fossa, as these are excluded from most current clinical trials. Existing studies were mostly carried out before the present millennium began, and limitations are evident in the adaptation of those results and recommendations to current management, with today’s technological and diagnostic possibilities. We therefore recommend the re-evaluation of brainstem haemorrhages in the modern neurosurgical and intensive care environment.
Highlights
Terminology The American Heart Association/American Stroke Association (AHA/ASA) has defined an intracerebral haemorrhage (ICH) as a focal collection of blood within the brain parenchyma or ventricular system that is not the result of trauma
Despite all these variations in anatomical classification systems, the literature agrees on the following points: haematoma size and radiological signs of acute hydrocephalus correlate with poor outcomes [11, 15, 21, 23,24,25,26,27]
Observational, single-centre study that focused on the comparison of decompressive craniectomy, medical therapy and external ventricular drain (EVD) placement in patients with haemorrhages in the posterior fossa, Luney et al found a significant increase in hydrocephalus and intraventricular bleeds in patients treated with EVD placement [47]
Summary
Wang Sophie S.a, Yang Yanga, Velz Juliaa, Keller Emanuelaa, Luft Andreas R.bc, Regli Lucaa, Neidert Marian C.a, Bozinov Olivera a Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland b Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland c Cereneo, Centre for Neurology and Rehabilitation, Vitznau, Switzerland.
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