Efficiency and influence factors of stereotactic precision aspiration in the treatment of primary brain stem hemorrhage

Objective To investigate the efficiency and influence factors of stereotactic precise aspiration in treatment of primary brainstem hemorrhage. Methods A total of 47 patients with primary brainstem hemorrhage who underwent stereotactic precision aspiration from March 2014 to September 2018 at Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine were enrolled and their clinical data were collected. Surgical approach was chosen according to the location of the pons where the hematoma was located. Meanwhile, patients with postoperative hydrocephalus underwent external ventricular drainage. Intracranial residual hematoma volume was evaluated by CT scan on the first day post operation. Further follow-up at 30 days post surgery by phone or clinic was conducted to confirm the status of all patients. Univariate analysis and logistic regression analysis were performed to investigate the clinical factors associated with survival of patients.(ROC) curvecurve was further drawn to judge its predictive value. Results Among 47 patients, no death was reported during the operation. CT scan at day 1 post surgery showed that the average of intracranial residual hematoma volume in 47 patients was (2.7±0.9) ml (0-15.5 ml), and the clearance rate of hematoma was (75.0±24.2)%. In this series, 7 cases died and 40 survived within 30 days. The mortality rate was 14.9%. Univariate analysis revealed that classification of hematoma was the factor influencing postoperative mortality (χ2=13.689, P=0.033), which was confirmed by multiple logistic regression analysis (OR=0.053, 95% CI: 0.744-0.992, P=0.004). Further ROC curve results showed that the sensitivity and specificity of hematoma classification in predicting the prognosis of patients were 85.7% and 82.5%, respectively. Conclusions The new classification of brainstem hematoma is suitable for surgical planning and beneficial for prediction of the 30-day mortality. Key words: Cerebral hemorrhage; Brain stem; Treatment outcome; Factor analysis, statistical