This single-center prospective cohort study compared the efficacy of 3D-printed guide plate-assisted minimally invasive puncture and drainage (MIPD) with conservative treatment in managing primary brainstem hemorrhage (PBH).

Between May 2018 to January 2024, 70 PBH patients undergoing 3D-printed guide plate-assisted MIPD at our institution were enrolled as the treatment cohort. Seventy propensity score-matched PBH patients receiving conservative treatment during the same period served as controls. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 1 to 3 at the 90-day follow-up. Secondary outcomes comprised hematoma volume, National Institutes of Health Stroke Scale (NIHSS) scores assessed at admission and post-treatment, and incidence rates of complications (including hospital-acquired pneumonia [HAP], intracranial infection, rebleeding, hydrocephalus, and seizures).

At 90 days, significantly more patients in the treatment cohort achieved favorable outcomes (mRS 1-3: 41.4% vs 22.9%,  ). Postoperative hematoma volumes and NIHSS scores were significantly reduced in the treatment cohort compared to the control cohort (both  ). The treatment cohort had significantly lower incidence of HAP (11.4% vs 28.6%,  ) and intracranial infection (1.4% vs 11.4%,  ). No significant between-group differences were found in rebleeding, hydrocephalus, or seizure rates (all  ).

3D-printed guide plate-assisted MIPD demonstrates superior efficacy over conservative treatment for PBH. This approach provides rapid hematoma clearance, mitigates neurological deficits, and reduces HAP and intracranial infection risks, translating to lower mortality and disability, supporting broader clinical implementation pending multicenter validation.