To investigate the clinical efficacy of the suboccipital posterior median-telovelar approach for hypertensive pontine hemorrhage.

The clinical data of 8 patients with primary hypertensive pontine hemorrhage, who were treated by the suboccipital posterior media-telovelar approach from January 2023 to September 2023 in the Department of Neurosurgery at Zhongshan Hospital Xiamen University, were retrospectively analyzed. Univariate analysis assessed factors related to 6-month mortality, including age, gender, admission systolic blood pressure, admission diastolic blood pressure, preoperative Glasgow coma score (GCS), endotracheal intubation upon admission, time from onset to operation, hemorrhage volume, postoperative residual and hematoma clearance rate, and postoperative intracranial infection. Outcomes were assessed by the 6-month Glasgow outcome scale (GOS). Statistical analysis was performed using SPSS 26.0 software. Continuous variables were compared using the t-test or Mann-Whitney U test based on distribution characteristics; categorical variables were analyzed with Fisher's exact test.

Of the 8 patients included, 5 survived and 3 died within 6 months. No significant differences were observed between the nonsurvival group and the survival group in mean age, gender, admission systolic blood pressure, admission diastolic blood pressure, preoperative tracheal intubation, time from onset to operation, and intracranial infection (all P>0.05). Significant differences were observed between the nonsurvival and survival groups regarding preoperative GCS score [5.0 (5.0, 5.0) scores vs 4.0 (3.5, 4.0) scores, Z=2.037, P=0.042], postoperative residual [0.2 (0.2, 0.4) mL vs 1.4 (1.4, 1.5) mL, Z=2.263, P=0.024], hematoma volume [(6.30±1.04) mL vs (9.47±1.50) mL, t=3.563, P=0.012], and hematoma clearance [(95.37±3.13)% vs (84.21±3.00)%, t=4.945, P=0.003]. GOS scores at 6 months were distributed as follows: Grade Ⅰ in 3 patients, Grade Ⅱ in 1, Grade Ⅲ in 3, and Grade Ⅳ in 1.

The telovelar approach facilitates early decompression and improves hematoma evacuation in pontine hemorrhage. Preoperative GCS score, bleeding volume, postoperative residual, and hematoma clearance were significantly associated with 6-month mortality.