E M r e a r t w r t i o p i b K w a p m m p w t o c t S pontaneous intracerebral hemorrhages (ICHs) bear a high mortality risk and are responsible for 10% to 30% of all stroke admissions to hospitals. The mortality rate of ICH accounts for 30% to 50%, and 20% of the patients involved are disabled after hemorrhage and mostly incapable of leading an independent, unsupported life (2). Although there are some theraeutic advances, the treatment of ICH is still controversially disussed in the pertinent literature. On the one hand, there is dvocacy for a conservative treatment option because some people ave the opinion that a surgical therapy is presumably worsening a atient’s outcome. This appraisal is referred to the first prospective andomized study from McKissock et al., published in 1961 (3), and as the code of best practice for a few years. One should keep in ind that this was the pre–computed tomography (CT) era, with imited surgical skills and restricted therapy in intensive care units. n the other hand, there is the concept of classical surgical therapy y evacuating spontaneous intracerebral hematomas microsurgially via craniotomy. A multitude of studies were performed and ublished dealing with these different concepts of ICH manageent, demonstrating controversial results. A subsequent publicaion on this topic described the opposite observation to what cKissock et al. have described in terms of a patient’s outcome fter surgery (1). These surgically treated patients with superficially ocated hemorrhages had a favorable outcome. They were treated y endoscopic hematoma evacuation. This trial was the onset of inimal invasive surgery for intracerebral hematoma evacuation. his minimally invasive technique was later supplemented by steeotactical CT-guided hematoma aspiration by using catheters laced into the hematoma with subsequent application of recombiant tissue plasminogen activator (rtPA).