Despite improvements in anesthesia, surgery, intensive care, and medical therapy, the outcome in patients with spontaneous ICH remains poor. Surgical evacuation is clearly indicated in viable patients who are herniating from large, supratentorial hemorrhages and in patients who deteriorate neurologically from an infratentorial hemorrhage. However, in the majority of patients who have small- and moderate-sized hemorrhages, the benefit of surgery has not been demonstrated, except with clots that are within 1 cm from the surface. Advances in newer and less-invasive surgical techniques might change that paradigm and result in improved outcome in patients with spontaneous ICH. Newer surgical techniques and improved medical treatments should remain a health-care priority, as the incidence of spontaneous ICH is likely to increase with the aging population.

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