The treatment of sICH is still controversial among neurosurgeons and neurologists. The focus of debate is whether evacuation of hematoma would be able to improve the prognosis of patients. Previous studies showed that the removal of hematoma might reduce nervous tissue damage, possibly by relieving local ischemia and removing noxious chemicals [
6]-[
8]. Several studies aiming to explore the efficacy of surgery for patients with sICH have been carried out but showed different results. In 1961, Mickissock and colleagues published the first prospective randomized controlled trial. Their results showed that patients treated surgically had worse outcome than the patients in the conservative group [
9]. Another influential study is the STICH series trials, which concluded that there was no overall benefit of early surgery for patients with supratentorial sICH compared with conservative treatment [
10],[
11]. Some researchers attributed this to additional surgical traumatization. In order to reduce surgical traumatization, some minimally invasive techniques have been used in hematoma evacuation. These minimally invasive techniques include stereotactic aspiration and neuroendoscope assisted surgery. The stereotactic aspiration guided by CT was successfully applied for hematoma evacuation by Backlund and collogues at 1978, and this minimally invasive surgery was further improved by some scholars [
12]. It was reported that the stereotactic aspiration combined with fibrinolytic drugs could be more effective in hematoma evacuation than aspiration alone [
13]. Another category of minimally invasive technique is neuroendoscope. Auer et al. reported that neuroendoscope could be applied to hematoma evacuation, but a subsequent randomized controlled trial showed that the outcome of surgical patients with putaminal or thalamic hemorrhage was not better than medical treatment [
14],[
15]. Recently, a lot of studies exploring the efficacy of minimally invasive surgery (MIS) compared with conservative craniotomy or medical treatment were carried out, but none of them provided sufficient evidence regarding the choice of treatment [
16]-[
20]. A further meta-analysis showed that patients with supratentorial intracerebral hemorrhage might benefit more from MIS than other treatment options [
21]. Though MIS seems less invasive than the traditional craniotomy, it was reported that the incidence of some complications (e.g. rebleeding and infection) was higher than craniotomy. In addition, with assistance of neuronavigation and operative microscope, hematoma evacuation by craniotomy could also be minimally invasive [
22],[
23]. Until now, there is no randomized controlled trial comparing the efficacy of neuroendoscopy, stereotactic aspiration and craniotomy in patients with spontaneous intracerebral hemorrhage except a small-scale trial by Cho and colleges. Thus, a large-scale clinical trial is necessary to provide robust evidence for clinical practice by assessing the safety and efficacy of different surgical methods including neuroendoscopy, CT-stereotactic aspiration and neuronavigation-assisted craniotomy for sICH. Here we designed a randomized, assessor-blinded, parallel-group, controlled, multi-center clinical study termed minimally invasive surgery treatment for patients with spontaneous supratentorial intracerebral hemorrhage (MISTICH).