In recent years, the incidence of cerebral hemorrhage in China has been on the rise year by year, and has become a common and frequent disease that seriously endangers people’s health, and as the weather gradually turns cooler, cerebral hemorrhage enters a high season. In fact, with the improvement of microsurgery technology, the mortality and disability rate of cerebral hemorrhage has been greatly reduced by surgical intervention, plus reasonable rehabilitation treatment. Cerebral hemorrhage, also known as cerebral hemorrhage, is actually a ruptured blood vessel in the brain parenchyma. It does not include traumatic cerebral hemorrhage and occurs mostly in middle-aged and elderly people, more in men than in women. The common cause of cerebral hemorrhage is hypertension. Some data show that more than 80% of patients with cerebral hemorrhage have a history of hypertension. Due to long-term hypertension, small arteries in the brain form corn-like sized aneurysms that expand, and under the action of certain factors, when the blood pressure suddenly rises, it can cause the tiny aneurysms to rupture and cerebral hemorrhage occurs. Long-term hypertension can also cause damage to the intima of small cerebral arteries, lipid deposition, hyaline changes, and increased fragility of the canal wall, making it easier to rupture and bleed. In addition, cerebral arteriosclerosis and cerebrovascular malformation are also common causes of cerebral hemorrhage. Any factors that can cause a sudden increase in blood pressure such as emotional excitement, strenuous activity, excessive drinking, straining to stool, and cold are all triggering factors for cerebral hemorrhage. Cerebral hemorrhage can occur in any part of the brain parenchyma and can be single or multiple. However, most hypertensive and cerebral atherosclerotic cerebral hemorrhages are single-onset. The preferred sites are the internal capsule and basal ganglia, followed by the external capsule and frontal lobe. Brain stem and cerebellum are less common. The onset of cerebral hemorrhage is more sudden, and the course of the disease progresses rapidly and, in severe cases, deteriorates within minutes or hours. Patients develop impaired consciousness, hemiparesis, vomiting, and fecal incontinence, which progresses further and leads to serious consequences such as brain herniation, coma, and death. In adults, the cranial cavity is a closed sclerotic cavity that cannot be expanded, so when intracranial hemorrhage occupies a certain volume, it will cause a gradual increase in intracranial pressure, leading to brain herniation and coma. The hematoma may collapse into the ventricle when it continues to increase, resulting in serious consequences such as central hyperthermia, deep coma, and even respiratory arrest and brain death. After cerebral hemorrhage, the blood clot accumulates in the brain parenchyma and takes about one month to be absorbed gradually. Therefore, if the hematoma in the cerebral hemisphere is large and exceeds 30 ml, leading to coma and life-threatening, early surgery must be performed to remove the hematoma and decompress it, so as not to miss the time. Therefore, the current view of the universal film is that for clear indications for surgery, ultra-early or early surgery should be pursued as soon as possible. In recent years, through continuous exploration, neurosurgeons have adopted surgical methods to treat cerebral hemorrhage, which has led to the successful recovery of many dying patients and even “resurrection from the dead”. The main purpose of surgery is to remove the hematoma as soon as possible, reduce the intracranial pressure and save lives, followed by reducing the compression of the surrounding brain tissue by the hematoma as early as possible to reduce the disability rate. The following methods are mainly used: debridement decompression, small bone window craniotomy, borehole aspiration, endoscopic hematoma removal, ventricular aspiration and so on. The specific surgical method used will be selected by the surgeon according to the amount of bleeding, the degree of impaired consciousness at the site, and the age of the patient. It is worth mentioning that in recent years, stereotactic technology, neuroendoscopic technology and neuronavigation have been applied to treat hypertensive cerebral hemorrhage, thus successfully avoiding the disadvantages of craniotomy such as high trauma, long operation time and high bleeding, and achieving better results. In particular, the combination of neuroendoscopy and locked-hole surgery for hypertensive cerebral hemorrhage is gradually being widely used. Its operation is performed outside the endoscope, with a bone window diameter of 1 to 2.5 cm. The endoscope can provide good illumination and clear, magnified images, so that the operator can clearly observe and remove the hematoma and stop the hemorrhage, and the advantages of microbone window opening can be retained, with less damage and easier control of deep bleeding and protection of the hematoma wall, which can achieve the purpose of proper hemostasis of bleeding on the opposite wall. So what kind of cerebral hemorrhage disease needs surgical treatment? (1) Bleeding in the basal ganglia: if the bleeding volume is ≥30ml, minimally invasive puncture hematoma removal or craniotomy with a small bone window can be selected at the right time according to the condition, bleeding site and medical conditions to remove the hematoma in a timely manner; for massive bleeding or brain herniation formation, decompressive hematoma removal with surgical debridement is required to save life. (2) Cerebellar hemorrhage: easily formed brain herniation, hemorrhage ≥10ml, or diameter ≥3cm, or combined with obvious hydrocephalus, should be treated by surgery as soon as possible in hospitals with conditions. (3) Lobar hemorrhage: in elderly patients, the hemorrhage is often due to amyloid angiopathy. Except for large hematoma which is life-threatening or caused by vascular malformation and requires surgical treatment, conservative medical treatment is recommended. (4) Ventricular hemorrhage: light partial ventricular hemorrhage can be treated conservatively by internal medicine; severe total ventricular hemorrhage (ventricular cast) requires ventricular puncture and drainage plus lumbar puncture and fluid release treatment. Rehabilitation treatment 1. Early hyperbaric oxygen therapy It has been found that the volume of cerebral ischemia secondary to cerebral hemorrhage can be more than several times that of the hematoma, and how to improve the blood supply and oxygen supply to the cerebral ischemic area secondary to cerebral hemorrhage is also one of the focal points of efforts. Hyperbaric oxygen can improve blood oxygen tension and diffusion distance, reduce cerebral edema, lower intracranial pressure, and promote neurological activity function has been widely confirmed by theory and practice, and has become the most effective means of cerebral hemorrhage rehabilitation at present. Therefore, early and persistent hyperbaric oxygen therapy is advocated for patients with cerebral hemorrhage. 2. Drug therapy Application of neurotrophic drugs and neurorehabilitation drugs So far, more than 40 kinds of neuroprotective treatments have been used clinically, but their efficacy varies, and many of them are not even effective. The ones that have been widely used are mainly membrane stabilizers, antioxidants and free radical scavengers. It is worth mentioning that another drug with dual role of neuroprotection and neurorepair, ganglioside, has been gradually taken seriously by neurological surgeons and pediatricians (for pediatric cerebral palsy), and has a definite role in the rehabilitation treatment of cerebral hemorrhage. 3. Prevent complications Prevent pneumonia, decubitus ulcers, venous thrombosis, etc. caused by bed rest, and turn and change the position regularly. Prevent and treat upper gastrointestinal bleeding If there is no upper gastrointestinal bleeding, early feeding should be done to promote the recovery of gastrointestinal function. Promote early recovery of the patient’s urinary and bowel autonomic functions, regular laxation, regular catheter clamping, regular opening, early removal of the catheter after the patient is awake, long-term coma patients should change the catheter from time to time, and bladder flushing when necessary. 4. Functional exercise (1) Functional exercise of the limbs Early prevention of joint ankylosis is required, and exercise therapy should be performed. The affected limbs should be maintained in a functional position at rest, such as shoulder abduction of 50°, internal rotation of 15°, forward flexion of 40°, appropriate dorsal extension of the wrist, and prevention of foot drop with a brace or splint. Early massage and passive activities of the affected limb should be carried out, with large amplitude and gentle movements in passive activities to avoid excessive stretching of the relaxed joints. Exercise time should be at least 1h per day. (2) Speech function rehabilitation Early promotion of early speech training: oral articulation training, teaching rhymes first, then vowels, learning glottal sounds first, then lip sounds, making the patient pronounce “ah” or inducing pronunciation by coughing, blowing paper, whistling, etc. Gesture training. Use gestures as a way to express verbal communication. Training with communication board. Select pictures of daily life to present to the patient. Repeatedly practice, without boredom, and gradually exercise the patient’s language skills. 5. Psychotherapy to promote patients’ psychological recovery After early recovery of consciousness, most patients with cerebral hemorrhage also have different degrees of negative psychological reactions in addition to physical disorders caused by brain damage, and these psychological problems greatly affect patients’ physiological and psychological recovery and quality of life. Patients with sudden onset of illness, lack of psychological preparation, manifesting as nervousness and fear; coupled with the pain and dysfunction of physical illness, often manifest as irritability and anxiety, and later, due to hospitalization, need for human care, inconvenient activities, self-esteem is impaired, resulting in depression and pessimism. Early psychotherapy, frequent contact with the patient to take the initiative to motivate and channel, trying to eliminate the patient’s self-pity, while mobilizing their friends and relatives to give the patient enthusiasm and warmth, to help solve certain economic difficulties, to promote the positive transformation of the patient’s psychology. In conclusion, cerebral hemorrhage is not a “hopeless” disease, as long as the correct understanding, choose reasonable treatment and pay attention to formal rehabilitation, many patients can still fully recover and return to normal life.