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06:33
Massive Pontine Hemorrhage by Dual Injection of Autologous Blood
Published on: May 29, 2021
Experiences in the management of brainstem hematomas
Veit Rohde1, Esther Berns, Ina Rohde
1Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany. veit.rohde@med.uni-goettingen.de
Neurosurgical Review
|May 9, 2007
Summary
Spontaneous brainstem hematomas (BSH) management differs by presentation. Arteriopathic BSH causing immediate coma have poor outcomes, while those caused by cavernomas in non-comatose patients benefit from surgery.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Spontaneous brainstem hematomas (BSH) are rare and present unique management challenges.
- Understanding the etiology and clinical course is crucial for optimizing patient outcomes.
Purpose of the Study:
- To review the clinical experience in managing spontaneous brainstem hematomas (BSH).
- To analyze treatment strategies and outcomes based on patient presentation and hematoma etiology.
Main Methods:
- Retrospective review of 58 consecutive patients with spontaneous brainstem hematomas (BSH).
- Data collected included demographics, symptoms, Glasgow Coma Scale (GCS), treatment, surgical findings, and Glasgow Outcome Scale (GOS).
Main Results:
- Fifteen comatose patients (GCS ≤ 4) had poor outcomes, with no survivors among those treated surgically or with external ventricular drainage for hydrocephalus.
- Arteriopathic BSH was suspected in 60% of comatose patients.
- Of 43 non-comatose patients, 83.7% had surgically treated cavernomas, while 14% had arteriopathic BSH managed medically.
Conclusions:
- Arteriopathic BSH causing immediate coma indicate severe damage and generally warrant conservative management, even with hydrocephalus.
- Surgical intervention is recommended for non-comatose patients with BSH, particularly when caused by underlying cavernomas.
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