Can brainstem hemorrhage be operated on?

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 07, 2024
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The brainstem is the center of human life, controlling vital functions such as breathing, circulation, heart rate, and blood pressure. Once bleeding occurs, patients often experience unstable vital signs, deep coma, and can die from brain function failure within a short period. Previously, it was believed that the brainstem was a no-go zone for surgery, and treatment for brainstem hemorrhage was primarily conservative medical therapy. However, with the continuous improvement of medical technology, neurosurgery departments in many top-tier hospitals have made significant achievements in minimally invasive or open surgeries for brainstem hemorrhages. Therefore, surgery for brainstem hemorrhage is not impossible and can be considered under specific circumstances.

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Written by Chen Yu Fei
Neurosurgery
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Can brainstem hemorrhage be cured?

For brainstem hemorrhages that have already occurred, the patient should be immediately taken to a local hospital. Initially, a cranial CT scan should be performed to determine the location and amount of bleeding in the brainstem. For minor brainstem hemorrhages, it is recommended to first use medication for treatment. This involves administering drugs that stop bleeding, enhance brain function, promote dehydration, and nourish the nerves, aiding in the gradual cessation of bleeding and the absorption of cerebral hematomas. Most patients can achieve very good treatment outcomes. However, if the brainstem hemorrhage is extensive, it often leads to severe brainstem dysfunction and typically has a poor prognosis.

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Written by Jiang Fang Shuai
Neurosurgery
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Is a brainstem hemorrhage serious?

Brainstem hemorrhage is a type of cerebral hemorrhage, occurring within the brainstem, which is the central hub of human life. Thus, once a brainstem hemorrhage occurs, the condition becomes extremely complicated and severe, with very high mortality and disability rates. Clinically, brainstem hemorrhages of less than three milliliters have a mortality rate close to 70%. Those exceeding five milliliters have a mortality rate close to 90%, and hemorrhages over ten milliliters are invariably fatal. In recent years, there has been an increasing trend in brainstem hemorrhages, affecting younger populations. This is mainly due to high work stress, uncontrolled diet, lack of exercise, and notably, a lack of awareness and attention to hypertension among young people, which ultimately leads to brainstem hemorrhage. Brainstem hemorrhage is a very dangerous disease.

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Written by Gao Yi Shen
Neurosurgery
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Brainstem hemorrhage blood pressure control range

The range of blood pressure control for brainstem hemorrhage must be specifically judged based on the current medical condition at the time. Generally speaking, it is optimal to maintain the systolic blood pressure between 110-120 mmHg. This can both ensure normal cerebral blood supply and reduce the risk of recurrent cerebral hemorrhage due to high blood pressure. However, each patient's baseline blood pressure is different, and many patients have a baseline systolic pressure higher than 180 mmHg. In such cases, it might be appropriate to adjust the target slightly higher, for instance around 130 mmHg. It is recognized that no one’s blood pressure can be perfectly consistent, so a certain degree of fluctuation is acceptable. Unless there are long-lasting high values, in which case, control within a certain range might be needed.

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Written by Jiang Fang Shuai
Neurosurgery
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Is brainstem hemorrhage dangerous?

The brainstem is the central hub of life in the human body, controlling vital functions such as blood pressure, pulse, respiration, body temperature, and consciousness. Bleeding in this area is extremely dangerous and is a life-threatening condition. Clinically, it has a high mortality and disability rate. For hemorrhages larger than 5 mL, most patients will succumb to central respiratory and circulatory failure within 48 hours. Even if the bleeding is less than 5 mL, although aggressive resuscitation may save the patient's life, most will suffer from severe brain dysfunction such as hemiplegia, aphasia, or a vegetative state. Therefore, brainstem hemorrhage is very dangerous.

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Written by Gao Yi Shen
Neurosurgery
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How long do you have to stay in the ICU for a brainstem hemorrhage?

The length of stay in the ICU for brainstem hemorrhage depends entirely on the patient's specific condition. Generally, as long as the patient's breathing is stable and they can breathe on their own, and all other vital signs are relatively stable, they can be transferred out of the ICU. However, this depends on the patient's condition at the time. Many patients are admitted to the ICU typically due to poor breathing and lack of autonomous respiration. If a ventilator is used and the results improve, they may then be transferred out. Some may be out in a week, while others may need one to two months. It is also crucial to determine whether they have developed ventilator-associated pneumonia, lower limb venous thrombosis, or other more severe clinical manifestations, so decisions should be made based on these conditions for accuracy.