OBJECTIVE: Spontaneous supratentorial intracerebral hemorrhage can be considered as one of the most common forms of cerebravascular disease. Effective reduction of intracranial volume buffering capacity in elevated intracranial pressure is most important factor related to a poor prognosis in cases with huge hematoma and compromised mental status. The role of surgery in the management of such cases are still controversial. METHODS: Thirty patients with altered mental status less than stuporous and spontaneous supratentorial hematoma were underwent craniotomy or decompressive craniectomy and duroplasty. The hematoma volume were ranging from 31 to 120ml. In 14 patients, in whom a progression in secondary brain swelling was expected to occur after hematoma evacuation, a decompressive craniectomy with dural enlargement was performed. The overall clinical result was expressed as 30 day mortality, Glasgow outcome scale(GOS) and modified Rankin scale 1 year after surgery. The favorable outcome(GOS> or =4) were analyzed with variables [age, initial Glasgow coma scale(GCS), hematoma volume, location of hematoma, extent of midline shift, intraventricular hemorrhage, and time interval from ictus to surgery]. RESULTS: The overall clinical results showed 10% of 0-day mortality, 56.6% of favorable outcome and 53.3% of independency(< or =2 of modified Rankin scale). A significant statistical correlation was found between outcome and initial GCS and location of hematoma(p<0.05). The decompressive craniectomy and duroplasty proved some useful in increasing postoperative GCS of compromised patients. CONCLUSION: Surgical treatment of patients with spontaneous supratentorial intracerebral hemorrhage with altered mentality less than stuporous can have a positive role, in selected cases.