There is no consensus of opinion on the treatment of hypertensive putaminal hemorrhage (HPH), especially in patients older than 65 years. The purpose of this study was to study the surgical outcome of HPH in patients older than 65 years while considering mortality and activity of daily life. Among eighty-three patients aged 65 or older with HPH, fifty-one patients received only medical treatment and 32 were operated upon to remove the hematoma. Each patient was measured by the intracerebral hemorrhage-intracranial hemorrhage grading scale (ICH Grade) which used the sum of eye opening and motor response scores derived from Glasgow Coma Scale. The cubic content of the HPH was calculated from measurement of maximum width (X), length (Y) and height (Z), and the hematoma volume taken as 1/2 that volume (X. Y. Z/2). The acute mortality in surgically treated group was 40.6% and three patients died during the follow-up period from one to six months after the operation. Determinant for the prognosis was the ICH grade and the volume of the hematoma. Patients who returned to ADL 1 and 2 (good recovery) after surgical treatment were 40.0% in ICH Grade I, 16.7% in ICH Grade II, and 20.0% in ICH Grade III. Among those patients who were in ICH Grade IV, none had good recovery. The acute mortality was zero in ICH Grade I, 16.7% in ICH Grade II, 40.0% in ICH Grade III, and 62.5% in ICH Grade IV. The crucial size was 60 ml with a mortality of 77.8% for hematomas larger and 39.1% for hematomas smaller than that. From our lim ited experience, we learned that operation in elderly patients with HPH was considered only in patients with hematomas between 20 to 60 ml, with a high operative mortality and only one-fourth having a good recovery postoperatively.