Prognosis and influencing factors of stereotactic intracranial hematoma aspiration for primary brainstem hemorrhage

Abstract BACKGROUND Primary brainstem hemorrhage (PBSH) is a very dangerous disease with a high mortality rate. There are few reports on stereotactic intracranial hematoma aspiration for PBSH, and its safety and efficacy have not been fully elucidated. Our objective was to investigate the prognostic and influencing factors of stereotactic intracranial hematoma aspiration for treating PBSH. METHODS The clinical data of patients with PBSH admitted to the Department of Neurosurgery and Intensive Care Unit of Tianjin Huanhu Hospital between January 2017 and December 2022 were retrospectively analysed. The clinical efficacy and factors affecting the prognosis were assessed using t tests, chi-square tests, and multivariate logistic regression analysis. RESULTS 53 patients with primary brainstem hemorrhage underwent stereotactic intracranial hematoma aspiration with no intraoperative deaths. 33 patients survived, while 20 died within one year of surgery. The 3-month, 6-month, and 12-month mortality rates were 28.30%, 33.96%, and 37.74%, respectively. 20 patients (37.74%) recovered fully consciousness after surgery. Blood pressure was within the normal range (p = 0.000) and significantly correlated with 12-month mortality and level of consciousness. Preoperative hematoma volume (p = 0.036) correlated significantly with 12-month mortality. Multivariate logistic regression analysis revealed that hematoma volume (B: 1.509, OR: 4.524, 95% CI: 1.027–19.927, p = 0.046) and controlled blood pressure within the normal range (B: -2.765, OR: 0.063, 95% CI: 0.013–0.302, p = 0.001) were independent factors for 12-month mortality. The blood pressure was within the normal range (B: -2.714, OR: 0.066, 95% CI: 0.015–0.294, p = 0.000), which independently influenced 12-month consciousness status. CONCLUSION Patients with smaller hematoma volumes and postoperative blood pressure control in the normal range had a relatively better prognosis. Stereotactic intracranial hematoma aspiration for PBSH has been shown to significantly reduce mortality and improve neurological function when the patient has a hematoma volume of 5 to 15 ml.