Abstract:

Objective To explore the surgical method of 3D⁃slicer Software combined with guided frame⁃ less stereotactic puncture for the treatment of brainstem hemorrhage and the prognosis of patients. Methods The clinical data on 31 patients with primary brainstem hemorrhage who had undergone 3D⁃slicer combined with naviga⁃ tion and frameless stereotactic puncture in our hospital from January 2019 to June 2021 were retrospectively ana⁃ lyzed. The grading of activity of daily living（ADL）was used as an index for assessing prognosis. Univariate and logistic regression analyses were used to identify independent risk factors affecting prognosis. ROC curves were drawn to measure the predictive value of risk factors. Results Univariate analysis showed that bleeding volume， hematoma type，PPH score，hydrocephalus，and hematoma volume before extubation were the influencing factors of prognosis（P < 0.05）. Logistic multivariate regression analysis showed that bleeding volume（OR = 1.297，P = 0.043），scores on new types of pontine bleeding（OR = 6.134，P = 0.015），and hematoma volume before extuba⁃ tion（OR = 1.561，P = 0.019）were independent risk factors affecting the prognosis of patients. The ROC curve showed that the bleeding threshold for a poor prognosis was 9.00 mL and the threshold of the residual hematoma before extubation was 2.85 mL. Conclusions The new surgical procedure provides a better prognosis in patients with brainstem hemorrhage. The prognosis is associated with bleeding volume，hematoma volume before extuba⁃ tion，and scores on new types of pontine hemorrhage.

Key words:

3D?slicer software, frameless stereotactic, brainstem hemorrhage, prognostic factors