Primary Brainstem Hemorrhage: A Review of Prognostic Factors and Surgical Management.

Danyang Chen,Qiang Dong,Yingxin Tang,Guofeng Wu,Wenjie Liu,Ping Zhang,Hao Nie,Zhouping Tang,Mengzhou Xue,Wenzhi Wang,Yuping Tang,Chao Pan

doi:10.3389/fneur.2021.727962

Abstract

Primary brainstem hemorrhage (PBSH) is the most fatal subtype of intracerebral hemorrhage and is invariably associated with poor prognosis. Several prognostic factors are involved, of which the two most predominant and consistent are the initial level of consciousness and hemorrhage size. Other predictors, such as age, hyperthermia, and hydrocephalus, are generally not dependable indicators for making prognoses. Scoring systems have now been developed that can predict mortality and functional outcomes in patients suffering from PBSH, which can thus guide treatment decision-making. A novel grading scale, entitled “the new primary pontine hemorrhage (PPH) score,” represents the latest approach in scoring systems. In this system, patients with a score of 2–3 points appear to benefit from surgical management, although this claim requires further verification. The four main surgical options for the treatment of PBSH are craniotomy, stereotactic hematoma puncture and drainage, endoscopic hematoma removal, and external ventricular drainage. Nevertheless, the management of PBSH still primarily involves conservative treatment methods and surgery is generally not recommended, according to current practice. However, the ongoing clinical trial, entitled Safety and Efficacy of Surgical Treatment in Severe Primary Pontine Hemorrhage Evacuation (STIPE), should provide additional evidence to support the surgical treatment of PBSH. Therefore, we advocate the update of epidemiological data and re-evaluation of PBSH treatment in a contemporary context.

Highlights

Primary brainstem hemorrhage (PBSH) is a type of spontaneous brainstem hemorrhage that is relevant to chronic hypertension but is not associated with definite or objective lesions such as cavernomas and arteriovenous malformations
Craniotomy is a classic surgical procedure used for PBSH, with advantage of definite hemostasis effect; stereotactic hematoma puncture and drainage is useful for patients who are reluctant to accept craniectomy or are old and feeble; endoscopic hematoma removal could provide adequate exposure of the ventral brainstem lesion when used in a special approach; EVD could be used in emergency medical treatment especially in primary hospitals
PBSH has a low incidence but high mortality compared to other forms of intracerebral hemorrhage (ICH) in which various prognostic factors are involved

Summary

INTRODUCTION

Primary brainstem hemorrhage (PBSH) is a type of spontaneous brainstem hemorrhage that is relevant to chronic hypertension but is not associated with definite or objective lesions such as cavernomas and arteriovenous malformations. In previous studies, depressed and poor initial levels of consciousness were usually described as “coma on admission” or measured by different GCS score critical thresholds in the range of

Design

Findings

CONCLUSIONS AND EXPECTATIONS