Primary brainstem hemorrhage (PBSH) is the most lethal subtype of hypertensive intracerebral hemorrhage, with reported mortality of 25–90%. Because of the brainstem’s delicate anatomy and high surgical risk, surgery remains controversial. This retrospective study analyzed 152 patients with severe PBSH admitted to a neurological intensive care unit between 2020 and 2023. Forty patients underwent modified frameless stereotactic minimally invasive drainage for intracerebral hemorrhage; 112 received non-surgical treatment. Cox regression, Kaplan-Meier/log-rank analysis and ROC curves were used.
Univariate analysis identified significant associations between prognosis and surgery, smoking history, homocysteine, cardiac arrest, mechanical ventilation, brainstem hemorrhage volume and spontaneous breathing at discharge (all p < 0.05). In multivariate analysis, surgery (HR = 0.583, 95% CI: 0.345–0.986) and spontaneous breathing at discharge (HR = 0.355, 95% CI: 0.196–0.645) were independent protective factors. Brainstem hemorrhage volume (HR = 1.049, 95% CI: 1.012–1.088) and cardiac arrest (HR=1.882, 95% CI: 1.135–3.120) were independent risk factors. The surgical group had significantly higher 180-day survival (p < 0.05), with median survival of 58 days versus 3 days in the non-surgical group. The combined prognostic model achieved an AUC of 0.838. The authors note limitations including the single-center retrospective design, small surgical subgroup and lack of randomization; multicenter validation is needed. These variables may aid risk stratification and individualized management of severe PBSH. The research, entitled “Effect of Minimally Invasive Drainage for Intracerebral Hemorrhage and Other Factors on Clinical Prognosis of Patients with Severe Brainstem Hemorrhage and Survival Analysis” was published in Translational Neurology and Neurosurgery (Volume 1, Issue 2, 2026)
DOI: 10.2738/TNN.2026.0009