Computed Tomography Guided Stereotactic Aspiration of Pontine Hemorrhages

Shitamichi, Masayuki; Nakamura, J.; Sasaki, T; Suematsu, Katsumi; Tokuda, Shoko

doi:10.1159/000100252

Cited by 19 publications

(19 citation statements)

References 6 publications

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“…Fourteen studies were excluded after the full-text review. Reasons for exclusion were as follows: lack of data on outcome score and mortality [7,15,16,18,40,48], no CM group [9,38], not tertiary hospital [25], no enough followup duration [46], lack of patient inclusion criteria [3], only external ventricular drainage for treatment group [49,51], overlapped patients population [10]. The PRISMA flow diagram was described (Fig.…”

Section: Resultsmentioning

confidence: 99%

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The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China: a review

2021

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Section: Resultsmentioning

confidence: 99%

“…Brainstem hemorrhage (BSH) accounts for 5–10% of intracranial hemorrhage, with overall mortality rate ranged from 25 to 90% [ 4 , 8 , 21 , 29 , 32 , 40 ]. It had been divided into two groups according to different pathophysiologic literature: hypertensive patients and normotensive patients.…”

Section: Introductionmentioning

confidence: 99%

The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China: a review

2021

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“…With the use of stereotactic equipment, anticoagulant urokinase, and rt-PA, it is endowed with high precision and a high hematoma clearance rate. A study by Shitamichi et al of 45 patients with PPH showed that CT-guided stereotaxic aspiration could improve the prognosis, especially for severe cases (88). In another study enrolling 37 PPH patients, Hara et al found that 72% (13 of 18) of subjects undergoing CT-guided stereotaxic aspiration showed a dramatic improvement, whereas only 42% (8 of 19) of subjects treated conservatively did (11).…”

Section: ) Stereotactic Hematoma Puncture and Drainagementioning

confidence: 99%

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

et al. 2021

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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.

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“…In an uncontrolled study of 175 putaminal lesions treated stereotaxically, outcome at 6 months was classified as "excellent" or "good" in 50% [50, Class III]. One series of 20 patients with pontine hemorrhages was treated with stereotaxic aspiration [51,Class III]. Of these, nine had "good" outcomes, and four had "fair" outcomes.…”

Section: Physical/speech Therapy and Exercisementioning

confidence: 99%

Intracerebral hemorrhage

SeestedtJr.

Frankel

1999

Curr Treat Options Neurol

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Patients with intracerebral hemorrhage should be admitted to an intensive care unit for experienced neurologic nursing care and close attention to vital signs. We recommend gentle reduction in blood pressure in individuals who present with elevated readings and in whom hemorrhage is felt to be secondary to hypertension. For the vast majority of nontraumatic intracerebral hemorrhages, the indications for surgery and use of intracranial pressure monitoring devices remain unproven. Surgery is indicated for notable exceptions, such as for patients with cerebellar hematomas (3 mL or larger) and for patients with temporal lobe hematoma and impending brain stem compression. In general, intracranial pressure (ICP) monitoring is advised to help guide treatment with hyperosmolar agents and hyperventilation when increased ICP is suspected. For patients with smaller supratentorial hematomas who are alert or somnolent, conservative treatment is optimal. Similarly, we support conservative management in patients older than 70 years of age who present with a hemorrhage of more than 50 mL and a Glasgow Coma Scale (GCS) score of less than 8. Insufficient data exist from large randomized and controlled studies to recommend surgical intervention as definitive treatment for the group between these two extremes.

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Computed Tomography Guided Stereotactic Aspiration of Pontine Hemorrhages

Cited by 19 publications

References 6 publications

The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China: a review

The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China: a review

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

Intracerebral hemorrhage

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