Intracerebral hemorrhage (ICH) accounts for half of stroke attributable deaths and two thirds of DALYs loss. Past well designed trials (2005 STICH, 2013 STICH 2, 2019 MISTIE 3, 2024 ENRICH, 2024 SWITCH) did not demonstrate benefits of surgery, aside from ENRICH which suggested improved functional outcome thanks to minimal invasive surgery for lobar ICH, but not for deep seated thalamic ICH. Since 2020, retrospective studies suggest great functional benefit of minimal invasive surgery for brainstem ICH.