Management of brainstem haemorrhages

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.

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

“…PBSH is the most fatal subtype of intracerebral hemorrhage (ICH) and invariably has a bleak prognosis (1)(2)(3). It has the clinical characteristics of sudden onset, rapid evolution, and high morbidity and mortality (4,5). Multiple studies have investigated the correlation between the prognosis of PBSH and its clinical features, neuroradiological presentation and neurophysiological properties (6)(7)(8).…”

Helicobacter Pylori Infection is Associated with an Increased Stress Ulcer Risk in Brainstem Hemorrhage Patients with Robot-Aided Stereotactic Hematoma Aspiration

“…Primary brainstem hemorrhage (PBSH) has the worst outcome among all types of spontaneous intracerebral hemorrhage (SICH) [1][2][3]. There was no standardized criteria to diagnose PBSH.…”

“…Generally, the diagnosis of PBSH is based on the history of hypertension, the clinical and radiological features after excluding other bleeding etiologies such as aneurysm, arteriovenous malformation (AVM), cavernomas and tumor apoplexy within brainstem [3,4]. The management of PBSH remains controversial [1,2].…”

Application of a 3D-Printed Navigation Mold in Puncture Drainage for Brainstem Hemorrhage

“…The treatment strategy for brainstem hemorrhage remains controversial. 10 Current guidelines recommend relatively conservative treatment for brainstem hemorrhage; however, this results in a higher mortality rate and poorer prognosis compared with surgical treatment. Many recent studies have found that some patients with brainstem hemorrhage do benefit from surgical intervention.…”