Anterior subtemporal approach for severe upper pontine hematomas: A report of 28 surgically treated cases

The efficacy and safety of surgery for patients with primary pontine hemorrhage (PPH) remain debatable. Twenty-eight consecutive patients with huge upper PPH were included in this study. They underwent surgical management through a subtemporal approach between January 2009 and October 2013. We analyzed clinical and radiological parameters to assess the patient outcomes. The near-complete (>90%) evacuation rate was 67.9%, and there was no surgery-related death. The overall survival rate at 3 months was 64.3% (17/28), including 28.6% (8/28) with good function, 10.7% (3/28) with disability and 25% (7/28) in a vegetative state. The mortality rate was 35.7% (10/28). Preoperative hemorrhage volume (P = 0.019), preoperative (P = 0.017) and postoperative (P = 0.001) Glasgow coma scale (GCS) score, coma on admission (P = 0.001), ventricular extension (P = 0.001), preoperative mechanical ventilation (P = 0.001) and hydrocephalus (P = 0.007) were found to be statistically significant predictors for mortality on univariate analysis. On multivariate regression analysis, only GCS on admission and coma were found to be significant prognostic predictors. The subtemporal approach was found to be a safe method to treat upper PPH. Microsurgery may be beneficial for the treatment of PPH, but these results need further validation in a more comprehensive and comparative study. GCS on admission and coma were found to be the only significant prognostic predictors for mortality with multivariate regression analysis.