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Shen J, Chen Q, Tong Q, Tian X, Han Q. Minimally invasive puncture and drainage guided by 3D printed guide plate for the treatment of primary brain stem hemorrhage. Eur J Intern Med 2024; 124:150-151. [PMID: 38461062 DOI: 10.1016/j.ejim.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Jun Shen
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, No. 62 Huaihai SouthRoad, Huai'an 223002, Jiangsu, China
| | - Quan Chen
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Qiang Tong
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Xiangyang Tian
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China
| | - Qiu Han
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'anNo.1 People's Hospital of Nanjing Medical University, No.1 Huanghe WestRoad, Huai'an 223300, Jiangsu, China.
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Tang Z, Huang W, Chen Q, Guo C, Zheng K, Wei W, Jiang Q, Yang R. Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage. Front Neurol 2024; 15:1352949. [PMID: 38469591 PMCID: PMC10925720 DOI: 10.3389/fneur.2024.1352949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Methods Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. Results A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Conclusion Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.
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Affiliation(s)
- Zhiji Tang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Weilong Huang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiqi Chen
- Department of Magnetoencephalography, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Changgui Guo
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Kuan Zheng
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Wenjin Wei
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
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Huang W, Chen Q, Liu L, Tang J, Zhou H, Tang Z, Jiang Q, Li T, Liu J, Wang D. Clinical effect of short-term spinal cord stimulation in the treatment of patients with primary brainstem hemorrhage-induced disorders of consciousness. Front Neurol 2023; 14:1124871. [PMID: 37006496 PMCID: PMC10064090 DOI: 10.3389/fneur.2023.1124871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveRecently, short-term spinal cord stimulation (st-SCS) has been used in neurorehabilitation and consciousness recovery. However, little is known about its effects on primary brainstem hemorrhage (PBSH)-induced disorders of consciousness (DOC). In this study, we examined the therapeutic effects of st-SCS in patients with PBSH-induced DOC.MethodsFourteen patients received a 2-week st-SCS therapy. Each patient's state of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R). CRS-R evaluation scores were recorded at the baseline (before SCS implantation) and 14 days later.ResultsOver 70% (10/14) of the patients (CRS-R score increased to ≥2 points) responded to the SCS stimulation after 14 days of st-SCS treatment. All items included in the CRS-R exhibited a significant increase post-treatment compared with pretreatment. After 2 weeks of st-SCS treatment, seven patients showed diagnostic improvement, resulting in a 50% (7/14) overall effective rate. Approximately 75% (3/4) of patients with minimally conscious state plus (MCS+) improved to emergence from MCS (eMCS), and 50% (1/2) of patients with vegetative state or unresponsive wakefulness syndrome (VS/UWS) improved to MCS+.ConclusionIn PBSH-induced DOC, st-SCS is a safe and effective treatment. The clinical behavior of the patients improved significantly following the st-SCS intervention, and their CRS-R scores markedly increased. This was most effective for MCS+.
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Affiliation(s)
- Weilong Huang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Qiang Chen
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Lin Liu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Jianhong Tang
- Laboratory Animal Engineering Research Center of Ganzhou, Gannan Medical University, Ganzhou, China
| | - Hua Zhou
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Zhiji Tang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Qing Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Tao Li
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Jianwu Liu
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Dong Wang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
- *Correspondence: Dong Wang
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Chen D, Tang Y, Nie H, Zhang P, Wang W, Dong Q, Wu G, Xue M, Tang Y, Liu W, Pan C, Tang Z. Primary Brainstem Hemorrhage: A Review of Prognostic Factors and Surgical Management. Front Neurol 2021; 12:727962. [PMID: 34566872 PMCID: PMC8460873 DOI: 10.3389/fneur.2021.727962] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 01/04/2023] Open
Abstract
Primary brainstem hemorrhage (PBSH) is the most fatal subtype of intracerebral hemorrhage and is invariably associated with poor prognosis. Several prognostic factors are involved, of which the two most predominant and consistent are the initial level of consciousness and hemorrhage size. Other predictors, such as age, hyperthermia, and hydrocephalus, are generally not dependable indicators for making prognoses. Scoring systems have now been developed that can predict mortality and functional outcomes in patients suffering from PBSH, which can thus guide treatment decision-making. A novel grading scale, entitled “the new primary pontine hemorrhage (PPH) score,” represents the latest approach in scoring systems. In this system, patients with a score of 2–3 points appear to benefit from surgical management, although this claim requires further verification. The four main surgical options for the treatment of PBSH are craniotomy, stereotactic hematoma puncture and drainage, endoscopic hematoma removal, and external ventricular drainage. Nevertheless, the management of PBSH still primarily involves conservative treatment methods and surgery is generally not recommended, according to current practice. However, the ongoing clinical trial, entitled Safety and Efficacy of Surgical Treatment in Severe Primary Pontine Hemorrhage Evacuation (STIPE), should provide additional evidence to support the surgical treatment of PBSH. Therefore, we advocate the update of epidemiological data and re-evaluation of PBSH treatment in a contemporary context.
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Affiliation(s)
- Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Nie
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guofeng Wu
- Department of Emergency, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mengzhou Xue
- The Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuping Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Apparatus Co., Ltd., Beijing, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen L, Chen T, Mao G, Chen B, Li M, Zhang H, Xi H, She X, Tang Z, Zhang P, Zhang Z, Cong L, Bao Y, Yang X, Zhao S, He C, Wen L, Zhang P, Xue M, Xue M. Clinical neurorestorative therapeutic guideline for brainstem hemorrhage (2020 China version). JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Brainstem hemorrhage (mainly pontine hemorrhage caused by hypertension) has the clinical characteristics of acute onset, rapid progress, high mortality, and high disability rate. Due to the complexity of the brainstem’s anatomical structure and functional importance, it is generally recognized that brainstem treatment is difficult and risky, so it has been regarded as a restricted area of surgery. However, in recent years, continuous progress is being made in many areas, including microsurgical technology, stereotactic technology, robot-assisted surgery, neuroendoscopy, and theoretical and clinical practice of neurorestoration, aiding in the understanding, diagnosis, and treatment of brainstem hemorrhage injuries. The Chinese Association of Neurorestoratology (CANR; Preparatory) and the China Committee of International Association of Neurorestoratology (IANR-China Committee) organized relevant experts to formulate this clinical guideline to diagnose and restore damaged nerves after brainstem hemorrhages, promote a standardized diagnosis, and neurorestoratologically treat this disease.
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