Background: Primary brainstem hemorrhage (PBH) is a type of spontaneous brainstem hemorrhage that is not associated with definite lesions. Currently, it is being debated whether to manage brainstem hemorrhage with conservative or surgical approaches, with some researchers suggesting conservative therapy, while others advocate for surgical treatment. The aim of this work is to present the first two cases operated on in Mali. Case Presentations: These were two cases selected according to the criteria defined by our team and were aged under 40 years, with a volume and Glasgow scale, operated on stereotactically with a frame. The calculation of the coordinates was manual. At 30 days post-operation, we had a 100% survival rate. Conclusion: Stereotactic evacuation of brainstem hematomas is possible in Mali; our results are encouraging, but a larger study is necessary.
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