Abstract Background: Management of spontaneous intracerebral haemorrhage (SICH) is still an enigma. The study was conducted to find out the most appropriate mode of treatment and other possible inclusion criteria's in addition to clot size. Methods: Sixty consecutive patients of SICH excluding bleeds due to arteriovenous malformations/aneurysm were included in the study. Patients with moderate and large bleeds, progressive neurological deficit and glasgow coma scale (GCS) of more than five were included in the surgical group and rest treated conservatively. Result: Location of the bleed, other co-morbid conditions and GCS at presentations were more important guidelines than size of the bleed. Mortality was more in surgically treated group where cerebellar bleed fared well after evacuation. Conclusion: Surgery is preferred in superficially located bleeds and cerebellar bleeds. Intra cranial pressure monitoring will help in categorizing the mode of treatment better than mere clot size.