Background: Spontaneous intracerebral hematoma (SICH) represents one of the major causes of mortality and disability. one of main direction of neurosurgery’s development in our days is to elaborate and to apply minimally invasive surgical methods of treatment in order to reduce intraoperative brain damage and to improve postoperative functional outcome. objective of the study. evaluation of effectiveness of minimal invasive methods of treatment in SICH comparatively with therapeutic treatment and classic surgery. Method: a retrospective research was perfomed on 102 of patients, hospitalized in the IMSp National Institute of Neurology and Neurosurgery during 2010-2013. Some indexes, such as mortality rate (M), survival rate according to the kaplan-Meier method and some scales, such as Glasgow outcome scale (GoS), Barthel index (BI), modified rankin scale (mrS) were used to evaluate primary and secondary outcome. Results: The patients were classified into 4 gr oups according to administered treatment. I- therapeutic treatment (n=37), II- classic craniotomy (n=24), III-minimal invasive craniotomy (n=13), IVpuncture and aspiration with use of local fibrinolysis (n=28). on discharging: I – M=67.6%, BI=38.5, GoS=3, mrS=3.7; II – M=41.7%, BI=55.7, GoS=3.5,mrS=3.1; III– M=46.2%, BI=51.4, GoS=3.3, mrS=3.4; IV– M=25%, BI=49.8, GoS=3.3, mrS=3.6. Secondary outcome after one year: I – M=78.4%, BI=91, GoS=4.4,mrS=1.8; II – M=50%, BI=97.8, GoS=4.8, mrS=0.7; III– M=53.8%, BI=93.3, GoS=4.7, mrS=1.0; IV– M=32.1%, BI=78.7, GoS=4.1, mrS=2.2. Conclusion: The method of puncture and aspiration of hematoma with use of local fibrinolysis showed its effectiveness by improving functional outcome and survival rate.