• Shinya Ichimura, Helmut Bertalanffy, Masato Nakaya, Yoichi Mochizuki, Goroku Moriwaki, Ryuichi Sakamoto, Masahito Fukuchi, and Koji Fujii.
• Department of Neurosurgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan; Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany. Electronic address: shinya3917@gmail.com.
• World Neurosurg. 2018 Dec 1; 120: e1289-e1294.

BackgroundIt remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly by surgical evacuation of the hematoma. In the present study, we discuss 5 cases of PBH that were treated surgically and the ability of surgical management to improve postoperative functional outcomes.MethodsThe 4 patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and trans-rhomboid fossa approach in the half-sitting position. The patient with a midbrain hemorrhage underwent surgery via the subtemporal approach in the supine lateral position. We analyzed the postoperative functional outcomes 1 week after surgery and the modified Rankin scale scores 6 months after discharge.ResultsThree patients with disturbance of consciousness experienced improvement in their level of consciousness. Four patients with hemiparesis improved in motor function. Oculomotor nerve function improved in 2 of 3 cases. Facial nerve function improved in 2 of 2 cases. Spontaneous respiration improved in 1 patient. The postoperative modified Rankin scale scores improved in all 5 cases.ConclusionsBecause of the good results with these 5 patients with PBH, this surgical strategy could be encouraged with exclusion criteria for early initiation of rehabilitation strategies. We hope to increase our number of patients to accumulate further evidence.Copyright © 2018 Elsevier Inc. All rights reserved.

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