The patient, Yao Moumou, male, 53 years old, with a history of hypertension for many years and poorly controlled blood pressure, had a sudden onset of confusion in a county-level city in Shanxi on May 30. The family decided to refer the patient to Shanghai Tenth People’s Hospital for treatment. With the strong remote inter-hospital transfer cooperation of sister units, the patient was safely delivered to Shanghai Tenth People’s Hospital for further treatment. Two days later, the patient’s level of consciousness decreased, the stabbing pain did not open the eyes, the limb flexion movements disappeared, and the re-examination of CT did not show the obvious expansion of the hematoma and the progress of hydrocephalus, but it was considered that the brainstem hematoma was large in size and the symptoms might be further aggravated at any time as the edema progressed. After obtaining the family’s understanding, a craniotomy was performed on June 8 for brain stem hematoma removal. The patient’s condition improved significantly after the operation, and he was able to open his eyes automatically and position his limbs during stabbing pain. The modern Internet-based teleconsultation mechanism, the increasingly perfect and powerful tele-transfer system and the strong ability to treat patients with neurocritical illnesses have bought a ray of hope for such patients. Figure 1 The patient’s sudden onset of illness on May 30 in a place in Shanxi Province, with a cranial CT indicating a brainstem hematoma combined with supratentorial acute hydrocephalus; Figure 2 The patient’s condition worsened, and a repeat CT indicated that although the hematoma did not increase significantly, the edema around the hematoma was obvious; Figure 3 The craniotomy was performed with a median suboccipital approach, separating the cerebellar medullary fissure and revealing the base of the fourth ventricle; Figure 4 The brain bridge and the dorsal brainstem tissue of the midbrain were revealed with localized yellow staining and bulging; Figure 5 In the brainstem tissue nearest to the hematoma, a small amount of brainstem tissue was picked up with a sharp knife to enter the hematoma cavity; Figure 6 The hematoma was removed strictly within the hematoma cavity by aspiration, and the brainstem tissue at the border of the hematoma was gradually reached; Figure 7 The hematoma was cleared, and the surface of the brainstem tissue within the hematoma cavity was dressed with surgicel and gelatin sponge, and the brainstem tissue was electrocautery as little as possible; Figure 8 The postoperative CT indicated satisfactory clearance of the hematoma within the brainstem.