[Surgical treatment for spontaneous intracerebral hemorrhage: exploration and evidence-based advances]

Spontaneous intracerebral hemorrhage (ICH) is characterized by acute onset and high rates of disability and mortality. Although surgical intervention is theoretically capable of decreasing intracranial pressure efficiently and mitigating secondary brain injury, its clinical benefit has long lacked high-level evidence. This article systematically reviews the evolution of ICH surgical treatment-from empirical attempts in the 17th century, through the establishment of early evidence-based guidelines in the CT era of the 20th century, to the conceptual innovation driven by minimally invasive technology in the 21st century. Currently, critical unresolved issues include optimal timing of surgery, selection of surgical approach, intelligent surgical technologies, selection for deep hemorrhage patients, and the surgery in brainstem hemorrhage. Future progress requires multicenter, high-quality clinical research to advance standardized, visualized, precise, intelligent, and homogeneous surgical interventions, thereby providing high-quality evidence from Chinese populations for the diagnosis and treatment of spontaneous ICH worldwide.