Efficacy of stereotactic puncture and drainage for primary brainstem hemorrhage

LIANG Aming; HAN Yi'na; DONG Rui; JIANG Yu; ZHANG Hui; MIN Youhui; GUO Zhixuan

doi:10.13798/j.issn.1009-153X.2026.01.002

Abstract：Objective To investigate the efficacy of stereotactic puncture and drainage for primary brainstem hem-orrhage and the factors influencing prognosis.Methods The clinical data of 95 patients with primary brainstem hemorrhage admitted to Zhengzhou Central Hospital from January 2015 to June 2024 were retrospectively analyzed.Among them,55 patients were treated with stereotactic puncture and drainage(surgical group),and 40 patients received conservative treatment(conservative group).Patients were followed up for 6 months after discharge,and prognosis was assessed using the GOS score.Considering the particularity of brainstem hemorrhage,a GOS score of 1～2 was defined as a poor prognosis,and 3～5 as a favorable prognosis.Results At the 6-month follow-up after discharge,the conservative group had 18 cases with GOS 1,20 with GOS 2,1 with GOS 3,1 with GOS 4,resulting in 2 cases with favorable prognosis.The surgical group had 5 cases with GOS 1,28 with GOS 2,20 with GOS 3,2 with GOS 4,resulting in 22 cases with favorable prognosis.Compared with the conservative group,the surgical group showed a significantly lower mortality rate(9.1%vs.45.0%,P<0.001)and a significantly higher rate of favorable prog-nosis(40.0%vs.5.0%,P<0.001).Multivariate logistic regression analysis indicated that a higher preoperative GCS score was associated with a better surgical prognosis,and patients with laterally-oriented hematomas also had a better surgical outcome.Conclusion Stereotactic puncture and drainage for evacuation of brainstem hematoma is an effective minimally invasive meth-od,demonstrating positive effects in reducing patient mortality and improving neurological function.Patients with laterally-orient-ed hemorrhages and those with higher preoperative GCS scores tend to have a better prognosis after surgical treatment.