<p>This study aimed to explore neurosurgeons’ knowledge, attitudes, and practices (KAP) concerning the employment of 3D-printed guide plates in the puncture and drainage procedures for intracerebral hemorrhage. An online cross-sectional survey was conducted among Chinese neurosurgeons using a self-designed KAP questionnaire from November 15 to December 30, 2023. Scores exceeding 70% of the maximum possible in each dimension were deemed indicative of sufficient knowledge (≥ 33.6), a positive attitude (≥ 28), and proactive practice behaviours (≥ 28). The study included 223 valid questionnaires. Of these respondents, 175 (78.5%) were male. The median scores for knowledge (potential range: 16–48), attitudes (potential range: 8–40), and practices (potential range: 8–40) were 37 (32, 47), 37 (32, 40), and 24 (17, 32) respectively. Multivariable logistic regression analysis indicated that the absence of training (OR = 0.273, 95% CI: [0.125,0.598], <i>P</i> = 0.001), relevant surgical experience (1–10 surgical cases: OR = 3.532, 95% CI: [1.405, 8.876], <i>P</i> = 0.007; more than 10 surgical cases : OR = 8.891, 95% CI: [2.275, 34.740], <i>P</i> = 0.002), knowledge (OR = 2.320, 95% CI: [1.105, 4.872], <i>P</i> = 0.026), and attitude (OR = 4.475, 95% CI: [2.183, 9.174], <i>P</i> &lt; 0.001) were independently associated with practices. Structural Equation Modelling (SEM) analysis demonstrated that knowledge not only had a direct effect on practice (β = 0.462, <i>P</i> = 0.010) but also had an indirect effect on practice through attitude (β = 0.145, <i>P</i> = 0.010). Neurosurgeons demonstrated adequate knowledge and favourable attitudes towards the use of 3D-printed guide plates in puncture and drainage surgery for intracerebral hemorrhage. However, their practical engagement was limited, underscoring the necessity for specialised training programmes to close this gap in practice.</p>