Spontaneous hypertensive brainstem hemorrhage: Does surgery benefit the severe cases?

•Hypertensive brainstem hemorrhage (HBSH) is defined as a diffuse brainstem hemorrhagic lesion occurring in an elderly patient.•HBSH is usually associated with systemic hypertension instead of brainstem cavernous malformation (BSCM)•Early surgical intervention is very crucial in achieving successful outcomes in patients with severe HBSH.•With the improvement in neuroimaging and microsurgical techniques, severe HBSH is no longer considered inoperable.