Abstract: Forty-eight patients with hypertensive intracerebral hemorrhage were admitted from January 1973 to January 1980. Thirty-two patients belong to external type. 12 internal type. and 4 subcortical type. In 15 cases the hematoma perforated into the ventricles. Craniotomy and evacuation of hematoma were done in all 48 cases. Twenty four patients survived. and 24 died, accounting for 50％ of operative mortality. If the 12 patients of Grade 5 were excluded, the operative mortality was 25％. In our opinion, the classification set forth in the 2nd Chinese Neuropsychiatry Meet-ing in 1978 does not seem to conform well with clinical impressions. It divides the patients into 3 grades. essentially on a basis of different degrees of coma. Thus, patients with clear, drowsy or stuporous state were not included. We suggest that a classifi-cation which categorizes patients into five grades. according basically to five degrees of mental state, i. e. clear, drowsiness. stupor, semicoma and coma. combining with other pertinent symptoms, would be more practical. Grade 1 or 2 patients should be treated conservatively. unless the hematoma is comparatively large. Operation is indicated for Grade 3 or 4 patients. As for the mori-bund patients belonging to Grade 5, surgery is contraindicated. The operative approach and technique are also discussed.