Comparison of the clinical effect of craniotomy hematoma evacuation and frameless stereotactic puncture and drainage guided by neuronavigation in the treatment of severe brain stem hemorrhage

Zhu Xihui; Wang Liushuai; Han Xinwang

doi:10.3760/j.issn.1673-4777.2025.09.010

Abstract：Objective To compare the clinical effects of craniotomy hematoma evacuation and frameless stereotactic puncture and drainage guided by neuronavigation in the treatment of severe brain stem hemorrhage.Methods Ninety patients with severe brain stem hemorrhage treated in Shijiazhuang People's Hospital,Hebei Province from May 2019 to May 2024 were selected.The patients were divided into control group(42 cases)and observation group(48 cases)according to different treatment methods.The control group was treated with craniotomy hematoma evacuation.The observation group was treated with frameless stereotactic puncture and drainage guided by neuronavigation.The effective rate,hematoma clearance,modified Rankin scale(mRS)score,Glasgow outcome scale(GOS)score and survival were compared between the two groups.Results At 3 months after operation,the significant effective rate of the observation group was higher than that of the control group[79.2％(38/48)vs 50.0％(21/42)](P=0.004).One week after operation,the hematoma clearance of the observation group was significantly higher than that of the control group[(5.4±1.1)ml vs(3.2±0.7)ml](P＜0.001).At 3 months after operation,the GOS score of the observation group was significantly higher than that of the control group[(4.2±1.0)vs(3.3±0.7)](P＜0.001).The incidence of complications in the observation group was significantly lower than that in the control group[8.3％(4/48)vs 31.0％(13/42)](P=0.006).At 3 months after operation,the mRS grade of the observation group was better than that of the control group(P＜0.05),and the mortality rate of the observation group was significantly lower than that of the control group(P＜0.05).Conclusion Compared with craniotomy hematoma evacuation,frameless stereotactic puncture and drainage guided by neuronavigation in the treatment of severe brain stem hemorrhage can further increase the amount of hematoma removed,reduce postoperative complications,and be beneficial to the prognosis of patients.