Surgical Treatment for Severe Primary Midbrain and Upper Pons Hemorrhages Using a Subtemporal Tentorial Approach

Jie Wu; Xiao Wu; Yong Zhang; Wei Du; Ke Wei; Guo Jie Yao

doi:10.1055/s-0042-1745737

Surgical Treatment for Severe Primary Midbrain and Upper Pons Hemorrhages Using a Subtemporal Tentorial Approach

J Neurol Surg B Skull Base. 2022 Apr 19;84(3):281-287. doi: 10.1055/s-0042-1745737. eCollection 2023 Jun.

Authors

Jie Wu¹, Xiao Wu², Yong Zhang³, Wei Du¹, Ke Wei¹, Guo Jie Yao¹

Affiliations

¹ Department of Neurosurgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, China.
² Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
³ Department of Neurosurgery, Beidaihe Rehabilitation and Recuperation Center of Chinese People's Liberation Army, Qinhuangdao, China.

Abstract

Objectives It is unclear whether surgical hematoma evacuation should be performed in cases of primary brainstem hemorrhages (PBH). Here, we analyzed 15 cases with severe primary midbrain and upper pons hemorrhages to assess the associations between the subtemporal tentorial approach and patient functional outcomes and mortality. Design A total of 15 patients diagnosed with severe primary midbrain and upper pons hemorrhages who had previously received the subtemporal tentorial approach at our facility from January 2018 and March 2019 were analyzed. All surviving cases received a follow-up at 6 months after surgery. The Glasgow Coma Scale and Glasgow Outcome Scale (GOS) scores were analyzed 1 and 6 months after surgery, respectively. Demographic data, lesion characteristics, and follow-up data were retrospectively collected. Results All patients successfully underwent surgical evacuation for hematomas using the subtemporal tentorial approach. The overall survival rate for these cases was 66.7% (10/15). At the last follow-up, 26.7% of patients (4/15) exhibited healthy function (GOS score: 4), 20.0% (3/15) showed disability (GOS score: 3) and 20.0% (3/15) were in a vegetative state (GOS score: 2). Conclusions Based on the results uncovered in this study, the subtemporal tentorial approach was found to be both safe and feasible and may be beneficial for the treatment of severe primary midbrain and upper pons hemorrhages, but a more comprehensive and comparative study is required to further confirm these results.

Keywords: outcomes; primary brainstem hemorrhage; subtemporal tentorial approach.

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