Primary brainstem hemorrhage (PBSH) is a life-threatening neurological emergency characterized by high mortality and disability rates. Due to the deep anatomical location of the brainstem and its proximity to critical neurovascular structures, traditional surgical interventions pose significant risks, and optimal treatment strategies remain controversial. With the rapid advancement of neurosurgical robotic technologies, robot-assisted interventions have emerged as a promising alternative for PBSH, offering enhanced precision and minimally invasive access. This review summarizes the core technological principles of neurosurgical robots, current clinical applications in PBSH, therapeutic outcomes, and safety profiles. Additionally, we discuss key factors influencing treatment efficacy, aiming to provide valuable insights for clinical decision-making.