Objective To explore the clinical efficacy of a neurosurgical stereotactic surgical robotic system for severe brain stem hemorrhage. Methods From March 2018 to December 2022， 52 patients with severe brainstem hemorrhage admitted to the Department of Neurosurgery of South Taihu Hospital Affiliated to Huzhou College were selected for the study. The patients were divided into control group （n=23） and study group （n=29） based on different treatment. Surgical treatment group was treated with stereotactic robot to perform brainstem hematoma removal by puncture and drainage or hematoma removal by puncture and drainage plus extracerebral ventricular drainage. Control group was treated with medication and/or extracerebral ventricular drainage. Postoperative 30-day mortality， severe disability rates， complications， and Modified Rankin Scale （mRS） scores were compared between the two groups. Cox survival analysis was used to verify the effects of group， gender， age， hematoma volume， pulmonary infection， and intracranial infection factors on the prognosis and survival time of patients with severe brainstem hemorrhage. Results There was no statistically significant difference in Glasgow Coma Scale （GCS） score， mean hematoma volume， and gender between the two groups at the time of admission （P ＞ 0.05）， and the difference in age was statistically significant （P ＜ 0.05）. Postoperative 30-day mortality in study group was 17.24% （5/29）， which was lower than that of 56.52% （13/23） in control group， and the difference was statistically significant （P ＜ 0.05）. The 90-day mRS score in study group was 4.0 （4.0， 5.0）， which was lower than that in control group， which was 6.0 （5.0， 6.0）， and the difference was statistically significant （P ＜ 0.05）. The postoperative severe disability + mortality in study group was 27.59% （8/29）， which was lower than that of 73.91% （17/23） in control group， and the difference was statistically significant （P＜ 0.05）. Cox survival analysis showed that patients in study group had a longer survival time than control group， and patients without lung infection had a better survival time than patients with lung infection. Conclusions Surgical robotic frameless stereotactic puncture for removal and drainage of severe brainstem hemorrhage is effective， and the method can be applied clinically to reduce mortality， but the rate of severe disability remains high.