Stereotactic Hematoma Puncture and Drainage for Intracerebral Hemorrhage: A Narrative Review

Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high mortality and long-term neurological disability. Conventional surgical evacuation through craniotomy carries substantial risks, particularly for deep-seated hematomas. This narrative review summarizes current evidence on precision neurosurgical approaches for ICH management, including stereotactic intracranial hematoma puncture and drainage, neuroendoscopic techniques, and emerging robotic-assisted interventions. Minimally invasive strategies aim to reduce surgical trauma and facilitate hematoma evacuation, and several clinical studies suggest potential improvements in perioperative safety and functional recovery. However, reported outcomes remain variable across trials, and the overall strength of evidence continues to evolve. Advances in surgical navigation, three-dimensional planning, augmented visualization, and artificial intelligence-assisted guidance may enhance procedural accuracy and decision-making. Despite these technological developments, important challenges remain regarding patient selection, timing of intervention, and standardization of surgical protocols. Further large-scale clinical studies and broader validation of emerging technologies are required to clarify the clinical role of precision neurosurgical techniques in the management of intracerebral hemorrhage.