The surgical treatment of spontaneous intracerebral hematoma has been a controversial subject since neurosurgery began to develop. In our midst we now feel that the surgical treatment should be done early, when the patient presents with the precise indications, since this is the only way to protect the brain from the more or less sudden mass effect to which it is subjected. We have operated on 47 patients (33 men and 14 women) who were from 14 to 82 years old of age (with an average of 56 years), with an intracerebral hematoma in one or the other of the cerebral or cerebellar hemispheres, of varied etiology (most frequently, arterial hypertension). We analyzed the diagnostic methods and the surgical procedures performed on our patients, and emphasize the importance of other methods, such as stereotaxic localization, which shows much promise, especially for gravely ill patients in whom any conventional intervention carries a great risk. The results were excellent in three patients (6.3%) because they returned to their original occupation; good in 9 (19%), who were able to be gainfully employed; bad in 9 (19%), who remained partially or totally dependent, and 26 patients (55.3%) expired. Today, in spite of technical advances, there has been little change in the morbidity and mortality of patients with hematomas of more than 50 ml.