Hypertensive brainstem hemorrhage （HBSH） has the poorest prognosis and highest mortality rate among all cerebrovascular diseases， and current treatments mainly focus on conservative medical management both domestically and internationally. However， with the continuous advancement in knowledge of brainstem anatomy and functional areas， as well as the progress in new technologies and equipment in the fields of neuroimaging， microsurgical techniques， neuro-navigation， neuroendoscopy， intraoperative monitoring， and neurorehabilitation， there are now options and guarantees for the development of "minimally invasive" surgical treatments for brainstem hemorrhage. Surgical evacuation of the hematoma can reduce its mass effect， alleviate compression on the brainstem， and mitigate the cytotoxic effects caused by the breakdown of blood products during the absorption phase. This article provides an overview of the application and progress of microhematoma evacuation surgery in HBSH. ［Journal of International Neurology and Neurosurgery, 2023, 50(4): 54-60］