The history of treatment approaches to intracerebral hemorrhage (ICH) involved testing various strategies based on the understanding and perceived importance of the components of ICH pathophysiology. These included attempts at (1) limiting the deleterious effects of ICH on surrounding brain parenchyma, (2) accelerating ICH and intraventricular hemorrhage (IVH) resolution, and (3) controlling the effects of hematoma expansion. The chronological sequence in which these approaches were applied reflects, in part, the timing of new advances in the understanding of the various factors that contributed to the morbidity and mortality of ICH. These approaches include both medical and surgical interventions. Treatment of ICH has required collaboration between neurologists and vascular neurosurgeons. The dramatic events at onset of ICH present clinicians with the option of early surgical intervention as a lifesaving approach for a condition of high mortality, along with nonsurgical measures that may contribute to improved outcomes.