Dutch Intracerebral Hemorrhage Surgery Trial

Inclusion Criteria: 1. Age 18 years or older; 2. NIHSS ≥ 2; 3. Supratentorial non-traumatic ICH confirmed by non-contrast CT, without a CT-angiography confirmed causative vascular lesion (e.g. aneurysm, arteriovenous malformation \[AVM\], dural arteriovenous fistula \[DAVF\], cerebral venous sinus thrombosis \[CVST\]), or other known underlying lesion (e.g. tumor, cavernoma); 4. Minimal hematoma volume of 10 mL; 5. Intervention can be started within 8 hours of symptom onset; 6. Written informed consent (deferred). Exclusion Criteria: 1. Considerable pre-stroke dependency in activities of daily living, defined as a pre-stroke mRS ≥3; 2. ICH-GS score ≥11; 3. Hemorrhage due to hemorrhagic transformation of an infarct; 4. Untreated coagulation abnormalities, including INR \>1.3 (point of care measurement allowed), treatment with heparin and treatment with factor Xa inhibitors. Patients on vitamin K antagonist can be included after correction of the INR, and patients on dabigatran (direct thrombin inhibitor) can be included after reversal of dabigatran with idarucizumab; 5. Moribund (e.g. coning, bilateral dilated unresponsive pupils), or progressively deteriorating clinical course with imminent death; 6. Pregnancy (note: most patients will be beyond childbearing age); 7. DIST-INFLAME sub-study: patients that use immunosuppressive or immune-modulating medication.