Surgical treatment for primary brainstem hemorrhage to improve postoperative functional outcomes
EANS Academy. Ichimura S. 09/25/19; 275408; EP01133
Dr. Shinya Ichimura
Dr. Shinya Ichimura

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Abstract
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Background: It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. In the present study, we discuss five cases with PBH which were treated surgically, as well as the ability of surgical management to improve postoperative functional outcomes.
Methods: The four patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and transrhomboid fossa approaches in the half-sitting position, One patients with medullary hemorrhage underwent surgery via midline suboccipital approach in the half-sitting position. One patient with midbrain hemorrhage underwent surgery via the subtemporal approach in the supine lateral position. We analyzed postoperative functional outcomes 1 week after surgery, as well as modified Rankin Scale (mRS) scores 6 months after discharge.
Results: Three patients with disturbance of consciousness experienced improvements in the level of consciousness. Four patients with hemiparesis improved in motor function. Oculomotor nerve function improved in two out of the three cases. Facial nerve function improved in two out of two cases. Spontaneous respiration improved in one patient. Postoperative mRS scores improved in all cases.
Conclusions: Because of good result of these five cases with PBH, this surgical strategy could be encouraged with exclusion criteria for early initiation of rehabilitation strategies. It is hoped to increase our cases to accumulate the further evidence
Background: It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. In the present study, we discuss five cases with PBH which were treated surgically, as well as the ability of surgical management to improve postoperative functional outcomes.
Methods: The four patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and transrhomboid fossa approaches in the half-sitting position, One patients with medullary hemorrhage underwent surgery via midline suboccipital approach in the half-sitting position. One patient with midbrain hemorrhage underwent surgery via the subtemporal approach in the supine lateral position. We analyzed postoperative functional outcomes 1 week after surgery, as well as modified Rankin Scale (mRS) scores 6 months after discharge.
Results: Three patients with disturbance of consciousness experienced improvements in the level of consciousness. Four patients with hemiparesis improved in motor function. Oculomotor nerve function improved in two out of the three cases. Facial nerve function improved in two out of two cases. Spontaneous respiration improved in one patient. Postoperative mRS scores improved in all cases.
Conclusions: Because of good result of these five cases with PBH, this surgical strategy could be encouraged with exclusion criteria for early initiation of rehabilitation strategies. It is hoped to increase our cases to accumulate the further evidence
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