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

Jung, Dae Sung; Jeon, Byung Chan; Park, Yong Sook; Oh, Hyung Suk; Chun, Tae Sang; Kim, Nam Kyu

Original Article

Journal of Korean Neurosurgical Society 2007;41(2): 82-87.

Dae Sung Jung, Byung Chan Jeon, Yong Sook Park, Hyung Suk Oh, Tae Sang Chun, Nam Kyu Kim

Department of Neurosurgery, Kosin University Gospel Hospital College of Medicine, Busan, Korea. jbcstar@kosinmed.or.kr

ABSTRACT

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 patients 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 diameter. 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.

Key Words: Pontine hemorrhage; Survival rate; Mortality; Outcome