From the Guidelines

Brainstem infarction management is primarily focused on preventing further neurological deterioration and managing complications.

Decompressive surgery: Although the provided evidence primarily discusses decompressive surgery for cerebellar and supratentorial infarctions, the principles of managing increased intracranial pressure and preventing further brain damage can be applied to brainstem infarctions as well 1.
Medical therapy: Patients with brainstem infarctions should be admitted to intensive care or stroke units for close monitoring and management of airway, blood pressure, fluids, glucose, and temperature 1.
Ventriculostomy: In cases of obstructive hydrocephalus, ventriculostomy may be necessary to relieve pressure, but this should be accompanied by decompressive surgery to avoid further complications 1.

Age and outcome: The evidence suggests that outcomes may vary based on age, with younger patients potentially having better functional outcomes after decompressive surgery 1.
Neurological deterioration: Patients who deteriorate neurologically despite maximal medical therapy may benefit from decompressive surgery, although the decision to operate should be made on a case-by-case basis 1.
Individualized care: Patient-centered preferences and preexisting decisions about end-of-life care should be taken into account when making management decisions, especially in cases of severe neurological injury 1.

From the Research

The management of brainstem infarction (cerebral infarction of the brainstem) involves various approaches, including:

Advanced neuroimaging techniques to identify patients who may benefit from thrombolysis 2
Administration of statins to improve prognosis, particularly in patients with infarctions located in the territory of multiple perforating arteries 3
Use of deep learning models to predict functional outcomes in patients with acute brainstem infarction, which can aid in decision-making and treatment planning 4
Clinical and electrophysiological criteria to establish the location of the lesion in patients with normal MRI results 5
Surgical management, such as microvascular decompression, for trigeminal neuralgia induced by brainstem infarct, although this approach may not be sufficient in all cases 6

The prognosis of patients with brainstem infarction varies on an individual basis, and poor prognosis is associated with:

Hemorrhagic complications 2
Infarctions located in the territory of multiple perforating arteries 3
Lack of administration of statins at discharge 3
High National Institutes of Health Stroke Scale score on admission 3
Unfavorable deep neuroimaging features extracted by convolutional neural networks (CNNs) 4

Treatment and intervention for brainstem infarction may include:

Thrombolysis for eligible patients 2
Statin therapy to improve prognosis 3
Surgical management for trigeminal neuralgia induced by brainstem infarct, although further investigation is needed to determine the most efficacious interventions 6
Use of deep learning models to predict functional outcomes and guide treatment planning 4