Evacuation of intracerebral hematoma is likely to be beneficial--against.

The 4 recognized surgical procedures to evacuate an intracerebral hematoma (ICH) are simple aspiration, craniotomy with open surgery, endoscopic evacuation, and stereotactic aspiration. Their use in clinical practice is inconsistent.1 In some countries (eg, the Netherlands) they are rarely performed; in others (eg, the United States) they are undertaken in about 20% of patients with ICH; and in others (eg, some centers in Germany and Japan) they are offered to 50% or more of patients.2 Such wide variation in practice reflects uncertainty about the effectiveness and risks of surgery, due to a lack of appropriate evidence. The required evidence is evaluation by large randomized controlled trials (RCTs), because RCTs minimize systematic biases and random errors that can otherwise falsely exaggerate or completely mask any real modest overall treatment effect of surgery (favorable and unfavorable).