Background There is still no consensus on whether primary pontine hemorrhage (PPH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. The purpose of this study was to assess the therapeutic effect of robotic frameless stereotactic aspiration with thrombolysis in the treatment of PPH.

Methods A total of 39 patients with PPH treated between January 2012 and November 2016 were included in the study. Sixteen patients underwent frameless stereotactic surgical treatment (ST group) and 23 patients underwent conservative treatment (CT group). Clinical and radiologic parameters were assessed, and the patient outcomes were analyzed over a 6-month follow-up period.

Results Surgical treatment did not result in any intracranial infections, or complications. Baseline characteristics did not significantly differ between the two groups. At discharge, the average Glasgow Coma Scale (GCS) score and the overall Glasgow Outcome Scale (GOS) score were significantly higher in the ST group compared to the CT group (p < 0.05). The mortality rate (GOS score 1) was significantly lower in the ST group (18.75%, 3/16) than in the CT group (52.17%, 12/23). For patients with hematoma volumes of 5 to 10 mL or GCS scores of 6 to 8, following treatment, the ST group exhibited markedly higher GOS scores in comparison to the CT group.

Conclusion Our study suggests that robotic frameless stereotactic aspiration with thrombolysis is a safe and efficient method for the treatment of PPH. Patients with hematomas of 5 to 10 mL or GCS scores of 6 to 8 could benefit from surgery.

This study was conducted ethically in accordance with the guidelines for human studies and the World Medical Association Declaration of Helsinki. The study protocol was reviewed and approved by the Ethic Committee of the Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital (approval number: 201604142k21).

All the patients' guardians gave their informed consent.

C.X. and H.Z. conceived the study and designed the protocol. H.Z. selected the patients and extracted the relevant information. C.X. and W.H. wrote the first draft of the manuscript. T.Y. organized the data. All the authors critically revised successive drafts of the article and approved the final version. J.M., H.Z., and C.X. are the study guarantors. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

*These authors contributed equally to this work.

Received: 19 July 2023

Accepted: 20 December 2023

Accepted Manuscript online:
27 December 2023

Article published online:
31 May 2024

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