Comparative analysis of stereotactic soft-channel and hard-channel aspiration in the treatment of primary brainstem hemorrhage
Objective To comparatively analyze the efficacy of stereotactic soft-channel aspiration surgery and hard-channel aspiration surgery in treating primary brainstem hemorrhage.Methods We retrospectively analyzed the clinical data of 146 patients with primary brainstem hemorrhage who were treated with stereotactic soft-channel aspiration surgery(n=65,soft-channel group)and hard-channel aspiration surgery(n=81,hard-channel group)at the Department of Neurosurgery of the First Hospital of Hebei Medical University from August 2014 to August 2023.Postoperative immediate head CT scan was performed to evaluate residual hematoma volume,and the duration of postoperative hematoma cavity drainage tube placement was documented.Follow-up assessments included the survival status of patients at 30 days post-operation,and the modified Rankin Scale(mRS)and Glasgow Outcome Scale(GOS)grades at 90 days post-operation.The mRS scores of 0-3 were considered as good neurological recovery,and GOS gradesⅣ～Ⅴ as favorable outcomes.Results There were no statistically significant differences between the soft-channel and hard-channel groups in terms of gender,age,or preoperative Glasgow Coma Scale(GCS)scores(all P＞0.05).All surgeries were successfully completed without postoperative rebleeding or other surgery-related complications.Compared with the soft-channel group,the hard-channel group had a significantly smaller immediate postoperative residual hematoma volume[M(Q1,Q3):0(0,0.3)ml vs.3.5(0.5,4.4)ml,Z=-7.54,P＜0.001],shorter duration of postoperative hematoma cavity drainage tube placement[M(Q1,Q3):1(1,2)d vs.3(2,4)d,Z=-7.09,P＜0.001],lower mortality rate at 30 days post-operation[14.8％(12/81)vs.41.5％(27/65),x2=20.19,P=0.035],and a higher proportion of patients with good neurological recovery[32.1％(26/81)vs.18.5％(12/65),x2=4.78,P=0.047].However,there was no statistically significant difference in the outcome at 90 days post-operation between the two groups(x2=6.28,P=0.189).Conclusion Hard-channel aspiration surgery for primary brainstem hemorrhage offers advantages over stereotactic soft-channel aspiration surgery in terms of more effective hematoma removal,reduced postoperative residual hematoma volume and mortality rate,and improved neurological function.
Cerebral hemorrhageBrain stemStereotaxic techniquesSuctionComparative study
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