en Basic Neurosurgery Research <div style="text-align: justify;"><strong>Background and Aim: </strong>To evaluate immediate outcomes and prognostic factors in surgical and medical treatment for spontaneous supratentorial intracerebral hemorrhage (SICH).<br> <strong>Methods and Materials/Patients: </strong>We prospectively investigated the two treatment groups, medical (88 patients) and surgical (40 patients), based on standard guidelines between May 2018 and November 2019. Immediate outcomes in the two groups were measured using the Glasgow outcome scale (GOS) at three months. Prognostic factors in the two groups were compared using the chi-square test.<br> <strong>Results: </strong>Of 128 patients with spontaneous SICH, 88 were in the medical group, and 40 were in the surgical group. The mean age of the medical group was 57&plusmn;13 years, and that of the surgical group was 53.7&plusmn;12 years. In both groups, the predominant bleeding site was the left capsuloganglionic region.<br> Hypertension was the most common risk factor in both groups (90%). In the medical group (n=88), 57 patients (65%) had good outcomes, and 31 patients (35%) had poor outcomes. In the surgical group (n=40), 19 patients (48%) had good outcomes, and 21 patients (35%) had poor outcomes. Mortality rates were 25% (n=22) in the medical group and 30% (n=12) in the surgical group till 3 months. Patients in our surgical group with intracerebral hemorrhage (ICH) score of 3 had a poorer outcome (68%) and lower mortality (46%) than those in the medical group (66% poor outcome and 55% mortality). The medical group with intraventricular hemorrhage (IVH) (n=28) had poor and good outcomes in 71% and 29% of cases, respectively. The surgical group with IVH (n=20) had poor outcomes in 85% of cases and good outcomes in 15% of cases. The medical and surgical groups without IVH had similar good outcomes in 80% of the cases.<br> <strong>Conclusion: </strong>The surgical group had improved outcomes compared to the medical group containing patients with midline shift >6 mm, >30 cc of bleed, and Glasgow coma scale (GCS) 8-12. With higher ICH scores and IVH, the surgical group showed poorer outcomes and fewer deaths.</div> Supratentorial, Intracerebral hemorrhage, Glasgow coma scale, Glasgow outcome scale (GOS), Decompressive craniectomy (DC) 0 0 http://irjns.org/browse.php?a_code=A-10-625-1&slc_lang=en&sid=1 Nitin Barde Dr.neetbarde@gmail.com 100319475328460012240 100319475328460012240 No Department of Neurosurgery, Vilasrao Deshmukh Government Medical College, Latur Superspeciality Hospital, Latur, India. Ramesh Chandra VV rcvvns@gmail.com 100319475328460012241 100319475328460012241 No Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India. Dattatray Kulkarni devdk.kulkarni@gmail.com 100319475328460012242 100319475328460012242 Yes Department of Neurosurgery, Vilasrao Deshmukh Government Medical College, Latur Superspeciality Hospital, Latur, India. Meghraj Chawada drmeghrajchawada@gmail.com 100319475328460012243 100319475328460012243 No Department of Neurosurgery, Vilasrao Deshmukh Government Medical College, Latur Superspeciality Hospital, Latur, India.