Effect Of Stereotactic Therapy On Severe Primary Cerebral Stem Hemorrhage And Its Prognostic Factors Influencing Its Mortality

Objective: To investigate the efficacy of stereotactic precise aspiration in the treatment of patients with severe primary brainstem hemorrhage and the predictors of its mortality.Methods : A total of 82 patients who received stereotactic precise aspiration for brain stem hemorrhage in the Department of Neurosurgery of the First Hospital of Hebei Medical University from January 2018 to October2020 were retrospectively included.The risk factors including gender,age distribution,body mass index(BMI)at admission,hypertension,diabetes,hematoma volume and other related risk factors were analyzed by Logistic regression analysis for univariate analysis to identify the risk factors for survival of patients with severe primary brainstem hemorrhage at 30 days after onset.Multivariate analysis of related risk factors was further performed by Logistic regression to determine the independent risk factors for 30-day death in patients with severe primary brainstem hemorrhage.Results: All 82 patients underwent surgical treatment,and none died during the operation.After 30 days of telephone or outpatient follow-up,among the 82 patients,40 survived and 42 died,with a survival rate of 48.8%.Univariate analysis showed that the predictors of 30-day postoperative mortality included hematoma type,hematoma volume,BMI,and presence or absence of ventricular hemorrhage.Age,sex,smoking history,alcohol consumption history,hypertension,diabetes,preoperative Glasgow coma index(GCS)score,and presence or absence of hydrocephalus were not associated with 30-day survival.Multivariate analysis showed that hematoma type,hematoma volume,BMI,and whether accompanied by ventricular hemorrhage were independent risk factors affecting the 30-day survival after surgery.Further use of the receiver operating characteristic curve(ROC)showed that BMI predicted survival with a sensitivity of 54.5% and specificity of 80%.The sensitivity and specificity of hematoma volume to predict patient survival were 54.8% and 92.5%.The sensitivity and specificity of hematoma classification to predict patient survival was 97.6% and 97.5%.Conclusions: The survival rate of patients with primary severe brain stem hemorrhage treated by stereotactic precise aspiration is higher.Among them,hematoma type,hematoma volume,BMI,and whether accompanied by ventricular hemorrhage are independent risk factors affecting the survival of patients at 30 days after surgery,and can predict the survival of patients.