OBJECTIVE: To clarify the prognosis of the patients with intra-sylvian hematoma (ISH) and intracerebral hematoma (ICH) in ruptured middle cerebral artery (MCA) aneurysms. METHODS: We categorized hematoma into ISH and ICH by the presence of intra-hematomal contrast enhancing vessel (IHCEV) on computed tomography angiography (CTA). Forty-four ruptured MCA aneurysm patients with ICH or ISH were grouped by the grading system proposed by the authors in our previous study. We investigated the relevance of the following factors: patient's age, gender, Hunt-Hess grade, Glasgow outcome scale (GOS) and changes in Glasgow coma scale (GCS) between pre-operation and 7 days after operation. RESULTS: There were no significant differences statistically in age, gender, Hunt-Hess grade, and GOS between the ISH and ICH groups. In their peri-operative GCS change, the ICH group showed greater improvement compared to the ISH group (p = 0.0391). The hematoma grade had a significant relevance with the patients' GOS. CONCLUSION: Although there were no significant statistic differences in the GOS of the 2 hematoma groups, there were prominent improvements of post-operative GCS in the ICH group. Unlike in the ISH group, effective removal of hematoma was possible in most patients of the ICH group. Thus although there is no difference in the prognosis of the 2 groups, early surgical evacuation of hematoma seems to be effective in improving the short-term GCS score in peri-operative period.