Cerebral hemorrhage sometimes requires neurosurgical evacuation. Mostly, surgery becomes an option when a patient has deteriorated. Deteriorating patients with spontaneous lobar intracerebral hemorrhage (ICH) might benefit from surgery, especially non-comatose patients with good rehabilitation potential and superficial hematomas without associated intraventricular hemorrhage. The indications for intervention, and particularly the timing of craniotomy, are discussed in this chapter. Surgery is indicated in patients with large cerebellar hematomas and considerable mass effect or obstructive hydrocephalus. Surgery is also indicated when ICH is due to underlying vascular anomalies or tumors. This chapter also reviews the available evidence from clinical surgical trials.