Neuroendoscopic Surgical Treatment of Hypertensive Brainstem Hemorrhage.

Abstract

Aim: To investigate the clinical effect of neuroendoscopic surgery on 15 patients with hypertensive brainstem hemorrhage (HBSH).

Material and methods: A retrospective analysis was conducted on the clinical data collected from 15 patients with HBSH and treated with neuroendoscopy between January 2021 and March 2023. Prior to surgery, head computed tomography (CT) data were imported into 3D-slicer software to reconstruct the hematoma in three dimensions, allowing for the calculation of hematoma volume. During surgery, neuroendoscopy was used to clear the hematoma, after which the hematoma clearance rate, along with 30-day and 90-day mortality rates, was calculated. Three months after surgery, the Glasgow Outcome Scale (GOS) was used to evaluate patient prognosis, calculate the good recovery rate, and assessed surgical efficacy.

Results: Re-examination of head CT images within 24 hours post-surgery revealed a hematoma clearance rate of > 90% in 11 cases and over 80?90% in four cases, with a mean hematoma clearance rate of 90.52±3.85%. There were no complications associated with postoperative rebleeding, intracranial infection, or the leakage of cerebrospinal fluid. Mortality rates on days 30 and 90 post-surgery were 26.7% (4/15) and 40% (6/15), respectively. After a 3-month follow-up period, GOS prognostic scoring revealed that one case had recovered well and could live a normal life, two cases had mild disability, and two cases had severe disability. Four patients survived in a vegetative state while six patients died; the good prognostic rate was 20% (3/15).

Conclusion: Neuroendoscopic technology is safe and effective for the treatment of HBSH. This method has a high hematoma clearance rate and a good clinical treatment effect with few postoperative complications.