Advances in Stereotactic Hematoma Evacuation for Hypertensive Intracerebral Hemorrhage and the Value of Multimodal Monitoring.

BACKGROUND: Hypertensive intracerebral hemorrhage (HICH) is a common spontaneous intracerebral hemorrhage with high morbidity and mortality. Early hematoma evacuation is critical to reduce secondary brain injury and improve neurological outcomes. SUMMARY: Stereotactic hematoma evacuation has emerged as a minimally invasive, precise surgical approach, particularly for deep-seated hematomas. Randomized controlled trials provide high-level evidence of safety advantages compared with craniotomy in selected patient subgroups, and observational studies further confirm this benefit in broader populations. Advances in imaging, neuronavigation, endoscopic assistance, thrombolytic therapy, and robotic guidance enhance surgical accuracy and safety. However, treatment outcomes vary considerably across different technologies. Multimodal monitoring, which integrates clinical scales, serum biomarkers, neuroimaging, intracranial pressure, cerebral perfusion, and brain oxygenation, enables a dynamic and quantitative assessment that guides surgical decision-making, perioperative management, and prognostic evaluation. Presently, the available evidence is largely theoretical and observational, with a notable absence of high-level evidence. KEY MESSAGES: The combination of stereotactic hematoma evacuation and multimodal monitoring enables individualized risk stratification, optimized intervention timing, and real-time evaluation of treatment efficacy, representing a promising precision-based strategy to improve prognosis in HICH patients.