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Abstract Spontaneous intracerebral hemorrhage (ICH), second most common cause of stroke, contributes largely to disability and morbidity. Surgical intervention for ICH reduces intracranial tension, decreases mass effects, improves perfusion, and prevents secondary injury. This study aims to evaluate the impact of different surgical interventions—microscopic evacuation (MS), endoscopic evacuation (EE), decompressive craniectomy (DC)—for ICH as described by modified Rankin scale (mRS), residual hematoma volume, complication rates, rebleed rates, intensive care unit (ICU)/hospital stay, and perioperative mortality. An observational prospective study (N = 54) was conducted over 2 years at a single center after ethical committee approval, with defined inclusion/exclusion criteria. Data were analyzed using SPSS version 26. Cohort comprised 74% males, with a mean age of 55.7 years; majority had hypertension and diabetes and presented with hemiparesis; 76% had capsuloganglionic location of ICH, 20% lobar, predominantly located on right side, with intraventricular hemorrhage (IVH) in 70%. Comparing the three groups, we found no statistical significance in demographics, preoperative/postoperative Glasgow coma scale), time to intervention, hematoma volumes, ICH score, postoperative complications, remnant ICH volume, tracheostomy rates, rebleed rates, and mortality. mRS at discharge/mRS at 3 months was not influenced by higher ICH volumes, presence of IVH, or older age. However, operative time (DC > EE and MS, p < 0.001), intraoperative blood loss (DC > EE, p = 0.001), and ICU and hospital days (EE > MS, p = 0.021, p = 0.044, respectively) were significant. Surgical options of ICH (MS, EE, and DC) note similar outcomes. However, EE can reduce operative times, intraoperative blood loss, while MS may contribute to lesser hospital days.