{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:55:33Z","timestamp":1781502933092,"version":"3.54.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014717","name":"Youth Science Fund Project","doi-asserted-by":"publisher","award":["82101403"],"award-info":[{"award-number":["82101403"]}],"id":[{"id":"10.13039\/100014717","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010166","name":"Xiamen Municipal Bureau of Science and Technology","doi-asserted-by":"publisher","award":["3502Z20214ZD1050"],"award-info":[{"award-number":["3502Z20214ZD1050"]}],"id":[{"id":"10.13039\/100010166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"publisher","award":["2020J05288"],"award-info":[{"award-number":["2020J05288"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed consecutive severe HPH patients (GCS 4-7, hematoma volume \u2265\u20095\u2005mL, 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 &amp;lt;\u20090.10 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 \u2265\u20094), and recorded perioperative complications, ICU and total hospital stay for all patients. Multivariate logistic regression identified independent prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05); the 30-day unfavorable functional outcome rate showed no significant difference between the two groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.087). 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\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1853742","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:37:58Z","timestamp":1781501878000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical intervention versus conservative care in severe hypertensive pontine hemorrhage: a retrospective analysis of clinical outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Ming-Lu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, China"]},{"name":"Department of Clinical Medicine, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Wang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Qiong","family":"Su","sequence":"additional","affiliation":[{"name":"College of Plant Science and Technology, Hunan Biological and Electromechanical Polytechnic","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu-Xiang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Jiang","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Hua","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-Jiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, Fujian, 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