Front Surg. 2026 Jun 15;13:1853742. doi: 10.3389/fsurg.2026.1853742. eCollection 2026.
ABSTRACT
BACKGROUND: Hypertensive pontine hemorrhage (HPH) carries high mortality and disability, with no standardized treatment guidelines. This study compared treatment efficacy for severe HPH and identified prognostic factors to guide clinical decisions.
METHODS: We retrospectively analyzed consecutive severe HPH patients (GCS 4-7, hematoma volume ≥ 5 mL, isolated pontine hemorrhage) treated at our center (2020-2024), stratified into pharmacological therapy, stereotactic drainage, and craniotomy evacuation groups. To eliminate treatment choice confounding bias, we performed 1:1 Propensity score matching (PSM) to generate an unbiased 112-patient cohort (56 pharmacological, 56 surgical), with standardized mean difference < 0.10 defining excellent intergroup balance. All core analyses were performed exclusively on this PSM-matched unbiased cohort. Inverse probability of treatment weighting (IPW) was used only as a sensitivity analysis to validate primary finding robustness. We assessed 30/90-day mortality and unfavorable functional outcomes (modified Rankin Scale ≥ 4), and recorded perioperative complications, ICU and total hospital stay for all patients. Multivariate logistic regression identified independent prognostic factors.
RESULTS: Post-PSM, all baseline covariates were well-balanced, eliminating treatment choice confounding bias. In the matched cohort, the surgical group had significantly lower 30/90-day mortality and 90-day unfavorable functional outcomes versus the pharmacological group (all P < 0.05); the 30-day unfavorable functional outcome rate showed no significant difference between the two groups (P = 0.087). These findings were fully validated by IPW sensitivity analysis. In surgical subgroup comparison, craniotomy achieved higher hematoma clearance but higher intracranial infection risk, while stereotactic drainage offered shorter ICU/hospital stays but higher rebleeding risk (all P < 0.05). Multivariate analysis identified older age, lower GCS score, larger hematoma volume, acute obstructive hydrocephalus, and massive hematoma morphology as independent adverse prognostic factors, with regular antihypertensive use as a protective factor.
CONCLUSION: In this PSM-matched cohort, surgery correlated with significantly reduced 30/90-day mortality and 90-day unfavorable functional outcome risk, with stereotactic drainage and craniotomy showing divergent safety-efficacy profiles. Findings do not constitute formal treatment recommendations, but may inform individualized clinical decisions based on patient and hematoma characteristics. This retrospective single-center study cannot establish definitive causality; results should be interpreted cautiously, with large-scale multi-center prospective trials in unbiased populations needed to verify robustness.
PMID:42376217 | PMC:PMC13311059 | DOI:10.3389/fsurg.2026.1853742