Minimally invasive puncture and drainage guided by 3D printed guide plate for the treatment of primary brain stem hemorrhage

Primary brainstem hemorrhage manifests rapidly and is linked to poor prognosis, boasting a high fatality rate. It is an acute and lethal neurological disorder. With a hemorrhage volume exceeding 5 mL, the mortality rate reaches around 90 %, and it nears 100 % with a volume surpassing 10 mL [ 1 AlMohammedi R.M. AlMutairi H. AlHoussien R.O. AlOtayan M.T. AlMutairi A.K. Bafail W.O. et al. Brainstem hemorrhage is uncommon and is associated with high morbidity, mortality, and prolonged hospitalization. Neurosciences. 2020; 25: 91-96 Crossref Scopus (6) Google Scholar ]. The risk of brain hemorrhage consistently rises with increasing age. However, it frequently occurs in middle-aged patients, with the highest incidence observed among individuals aged 40 to 60 [ 2 Gregson B.A. Mitchell P. Mendelow A.D. Surgical decision making in brain hemorrhage. Stroke. 2019; 50: 1108-1115 Crossref Scopus (42) Google Scholar ]. The brainstem, being relatively small and situated beneath the cerebellum and below the cerebrum, governs vital functions such as regulation of circulation, respiration, and digestion, serving as a paramount life center. Following brainstem hemorrhage, a hematoma rapidly forms, exerting pressure that distorts and shifts brainstem tissue and ventricular morphology. Furthermore, the hemorrhagic response continually stimulates brainstem tissues by generating inflammatory mediators, affecting vital organs associated with the respiratory, digestive, and circulatory systems, potentially leading to early-stage coma, fever, and even respiratory failure [ 3 Ichimura S. Bertalanffy H. Nakaya M. Mochizuki Y. Moriwaki G. Sakamoto R. et al. Surgical treatment for primary brainstem hemorrhage to improve postoperative functional outcomes. World Neurosurg. 2018; 120: e1289-e1e94 Crossref PubMed Scopus (29) Google Scholar ]. Owing to its unique anatomical location and physiological function, surgical treatment entails significant challenges. Presently, the primary clinical treatments for brainstem hemorrhage include hematoma evacuation through craniotomy, minimally invasive hematoma puncture and drainage, as well as endoscopic minimally invasive drainage [ 4 Chen L.H. Li F.J. Zhang H.T. Chen W.J. Sun K. Xu R.X. The microsurgical treatment for primary hypertensive brainstem hemorrhage: experience with 52 patients. Asian J Surg. 2021; 44: 123-130 Abstract Full Text Full Text PDF Scopus (13) Google Scholar ]. However, craniotomy for hematoma evacuation is less recommended due to its substantial risks, significant trauma, and considerable technical difficulty. On the other hand, minimally invasive hematoma puncture and drainage procedures are characterized by a shorter duration and decreased surgical trauma and are now widely used in the treatment of basal ganglia hemorrhage. However, precise positioning presents a challenge, limiting its application in the treatment of brainstem hemorrhage. In recent years, 3D printing technology has shown promising advantages in minimally invasive puncture treatment for hypertensive intracerebral hemorrhage due to its precise positioning, minimal surgical trauma, a closed drainage system, controllable drainage speed, and its ideal suitability for personalized treatment. It enables highly accurate surgical planning tailored to individual needs, enhances the success rate of complex surgeries, and ensures precision and safety [ 5 Wang Q. Guo W. Liu Y. Shao W. Li M. Li Z. et al. Application of a 3D-printed navigation mold in puncture drainage for brainstem hemorrhage. J Surg Res. 2020; 245: 99-106 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar ]. 3D printing technology was leveraged to fabricate a navigational template, facilitating the individualized and precise puncture drainage of brainstem hemorrhage. The aims were to evaluate the efficacy of 3D printing navigational templates in the minimally invasive treatment of brainstem hemorrhage.