Journal of Korean Neurosurgical Society

  • 제41권2호
  • /
  • Pages.82-87
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  • 2007
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

The Predictors of Survival and Functional Outcome in Patients with Pontine Hemorrhage

  • Jung, Dae-Sung (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine) ;
  • Jeon, Byung-Chan (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine) ;
  • Park, Yong-Sook (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine) ;
  • Oh, Hyung-Suk (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine) ;
  • Chun, Tae-Sang (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine) ;
  • Kim, Nam-Kyu (Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine)
  • 발행 : 2007.02.28
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초록

Objective : Pontine hemorrhages usually result in a much higher morbidity and mortality than any other intracranial vascular lesion. The purpose of this study was to evaluate survival and the contributing factors for patients with pontine hemorrhage. Methods : Of the 41 patients who were admitted to our hospital with their first acute pontine hemorrhage from 1997 to 2005, 35 patients were included in this study. Medical records were reviewed to confirm the accuracy of diagnosis and collect demographic, clinical and radiological data. The patients were divided into two groups, survivors and deceased patients; then the survivors were divided again into a group of patient with good results and those with poor results. The location of the hematoma, maximum anteroposterior [AP] diameter, maximum transverse diameter, hematoma volume, ventricular extension, extension into the midbrain, hydrocephalus and initial Glasgow coma scale [GCS] were evaluated. Results : The two year survival rate was 58.5%. The survival of patients with pontine hemorrhage was affected by initial GCS score and transverse hematoma dimeter. Functional outcome of patients who survived was affected by initial GCS, maximum transverse diameter, maximum AP diameter and hematoma volume. Conclusion : The rate of survival after pontine hemorrhage is associated with the transverse diameter of the hematoma and more importantly the initial GCS. Long-term outcome of survivors is influenced by the initial GCS, transverse diameter, AP diameter and volume. Through the multivariate analysis, initial GCS is the only significant factor on survival. Strictly speaking, initial GCS is not modifiable. However, surgical reduction may be considered to amend theses decisive factors. Additional study for indication, timing and method of surgical management is needed.

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참고문헌

  1. Adams HP Jr, Biller J : Hemorrhagic intracranial vascular disease. In Joynt Rj (ed) : Clinical neurology, Philadelphia : Lippincott, 1998, vol 2. pp1-64
  2. Balci K, Asil T, Kerimoglu M, Celik Y, Utku U : Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage. Clin Neurol Neurosurg 108 : 36-39, 2005 https://doi.org/10.1016/j.clineuro.2005.02.007
  3. Batjer HH, Kopitnik TA, Friberg L : Spontaneous intracerebral and intracerebellar hemorrhage, In Youmans JR (ed). Neurological surgery, ed 4. Philadelphia : WB Saunder, 1996, vol 2, pp1449-1464
  4. Bewermeyer H, Neveling M, Ebhardt G, Heiss WD : Spontaneous pontine hemorrhage. Fortschr Neurol Psychiar 52 : 259-276,1984 https://doi.org/10.1055/s-2007-1002024
  5. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G : Volume of intracerebral hemorrhage a powerful and easy-to-use predictor of 30-day mortality. Stroke 24 : 987-993, 1993 https://doi.org/10.1161/01.STR.24.7.987
  6. Bryan R, Weisberg L : Prolonged survival with good functional recovery in 3 patients CT evidence of brain stem hemorrhage. Comput Radiol 6 : 43-48, 1982 https://doi.org/10.1016/0730-4862(82)90180-9
  7. Burns J, Lisak R, Schut L, Silberberg D : Recovery following brain stem hemorrhage. Ann Neurol 7 : 183-184, 1980 https://doi.org/10.1002/ana.410070215
  8. Caplan LR : Clinical features of spontaneous intracerebral hemorrhage. In Kaufman HH (ed) : intracerebral Hematomas. New York : Raven Press, 1992, pp31-47
  9. Cho WJ, Moon SH, Lee SM, Yang JY, Choi CS, Ju MB : Clinical out-comes according to radiological classification of brainstem hemorrhages. J Korean Neurosurg soc 29 : 217-221, 2000
  10. Choi CW, Park DJ, Lee YW : Clinical analysis of the factors affecting the prognosis of spontaneous pontine hemorrhage. J Korean Neurosurg soc 26 : 1408-1412, 1997
  11. Christopher A, Lawrence M : Differential diagongis of altered states of consciousness, In Youmans JR (ed) : Neurological surgery, ed 5. Philadelphia : WB Saunder, 2004, vol 1, pp 278-279
  12. Chung CS, Park CH : Primary pontine hemorrhage : a new CT classification. Neurology 42 : 830-834, 1992 https://doi.org/10.1212/WNL.42.4.830
  13. Crowell RM, Ojemann RG, Ogilvy CS : Spontaneous brain hemorrhage : Surgical considerations. In Barnett HJM, Stein BM, Mohr JP, et al (eds) : Stroke-Pathophysiology, Diagnosis, and Management, 2d ed. New York : Churchill Livingstone, 1992, pp1169-1187
  14. Dziewas R, Kremer M, Ludeman P, Nabavi DG, Drager B, Ringelstein EB : The prognostic impact of clinical and CT parameters in patients with pontine hemorrhage. Cerebrovasc Dis 16 : 224-229, 2003 https://doi.org/10.1159/000071120
  15. Epstein A : Primary massive pontine hemorrhage. A clinicopathological study. J Neuropathol Exp Neurol 10 : 426-448, 1951 https://doi.org/10.1097/00005072-195110000-00008
  16. Fang HC, Foley JM : Hypertensive hemorrhages of the pons and cerebellum. Trans Am Neurol Assoc 13 : 126-130, 1954
  17. Fewel ME, Thompson BG Jr, Hoff JT : Spontaneous intracerebral hemorrhage : a review. Neurosurg Focus 15 : E1, 2003
  18. Hara T, Nagata K, Kawamoto S, Sashida J, Abe T, Wada A, et al : Functional outcome of primary pontine hemorrhage : conservative treatment or stereotaxic surgery. No Shinkei Geka 29 : 823-829, 2001
  19. Hong JT, Choi SJ, Kye DK, Park CK, Lee SW, Kang JK : Surgical outcome of hypertensive pontine hemorrhages : Experience of 13 cases. J Korean Neurosurg Soc 27 : 59-64, 1998
  20. Kase CS, Caplan LR : Hemorrhage affecting the brain stem and cerebellum. in Barnett HJM, Mohr JP, Stein BM, et al (eds) : Stroke. New York : Churchill Livingstone, 1986, pp525-547
  21. Kushner MJ, Bressman SB : The clinical manifestation of pontine hemorrhage. Neurology 35 : 637-643, 1985 https://doi.org/10.1212/WNL.35.5.637
  22. Kuwabara S, Ohta K, Ueda T, Yamane K, Uemura Y, Takahashi M : Clinical study of 20 cases of primary pontine hemorrhage. Neurol Med Chir (Tokyo) 22 : 933-942, 1982 https://doi.org/10.2176/nmc.22.933
  23. Link MJ, Bartleson JD, Forbes G, Meyer FB : Spontaneous midbrain hemorrhage : Report of seven new cases. Surg Neurol 39 : 58-65, 1993 https://doi.org/10.1016/0090-3019(93)90112-E
  24. Manno EM, Atkinson JL, Fulgham JR, Wijdicks EF : Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage. Mayo Clin Proc 80 : 420-433, 2005 https://doi.org/10.4065/80.3.420
  25. Masiyama S, Niizuma H, Suzuki J : Pontine haemorrhage : a clinical analysis of 26 cases. J Neurol Neurosurg Psychiatry 48 : 658-662, 1985 https://doi.org/10.1136/jnnp.48.7.658
  26. Murata Y, Yamaguchi S, Kajikawa H, Yamamura K, Sumioka S, Nakamura S : Relationship between the clinical manifestations, computed tomographic findings and the outcome in 80 patients with primary pontine hemorrhage. J Neurol Sci 167 : 107-111, 1999 https://doi.org/10.1016/S0022-510X(99)00150-1
  27. Niizuma H, Suzuki J : Computed tomography-guided stereotactic aspiration of posterior fossa hematomas : a supine lateral retromastoid approach. Neurosurgery 21 : 422-427, 1987 https://doi.org/10.1227/00006123-198709000-00029
  28. Ojemann RG, Heros RC, Crowell RM : Surgical Management of Cerebrovascular disease. 2d ed. Baltimore : William & Wilkins, 1988, pp435-449
  29. Phillip DS : History and physical examination, In Youmans JR (ed) : Neurological surgery, ed 5. Philadelphia : WB Saunder, 2004, vol 1, pp 277
  30. Rabinstein AA, Tisch SH, McClelland RL, Wijdicks EF : Cause is the main predictor of outcome in patients with pontine hemorrhage. Cerebrovasc Dis 17 : 66-71, 2004 https://doi.org/10.1159/000073900
  31. Sypert GW, Arpin-Sypert EJ : Spontaneous posterior fossa hematomas. In Kaufman HH (ed) : Intracerebral hematomas. New York : Raven Press, 1992, pp187-196
  32. Tanabe Y, Kondoh H, Funakoshi T : Clinical study of pontine hemorrhage. Jpn J Stroke 3 : 162-163, 1981
  33. Tanaka Y, Nishiya M, Suematsu K : Pontine hemorrhage. In Mizukami M, Kogure K, Kanaya H, et al (eds) : Hypertensive intracerebral hemorrhage. New York : Raven Press, 1983, pp205-214
  34. Wijdicks EF, Louis ES : Clinical profiles predictive of outcome in pontine hemorrhage. Neurology 49 : 1342-1346, 1997 https://doi.org/10.1212/WNL.49.5.1342