Primary brainstem hemorrhage (PBSH) is the most fatal subtype of cerebral hemorrhage, which is rapidly onset, with high disability and mortality, and a challenge to existing treatment methods. Due to the lack of relevant evidence-based medical research, there is no relevant expert consensus or guidelines in China or abroad. This paper summarized the experience of experts from two brain vascular surgery groups of the Chinese Medical Association and the Medical Association, and summarized the Chinese expert consensus. It was developed from the perspectives of risk factors, epidemiology, pathogenesis, diagnosis and evaluation, treatment, prognosis, prevention and intervention, and classified and elaborated on different treatment methods, in order to provide clinical treatment references and suggestions for PBSH.