Objectives: Comparison of two minimally invasive procedures for the treatment of intracerebral hemorrhage and subsequent lysis with regard to technical implications and clinical outcome of the patients. Methods: Retrospective analysis of 126 patients with spontaneous supratentorial intracerebral hemorrhage treated by frame- based (n = 53) or frameless (n = 75) hematoma aspiration and subsequent fibrinolysis with recombinant tissue plasminogen activator (rt- PA). Data were analysed for the whole group as well as for the two subsets of patients with regard to hematoma reduction, procedure- related complications, and the early and long term clinical outcome of the patients. Functional outcome was rated using the Glasgow Outcome Scale (GOS) and Barthel- Index (median follow- up 178 weeks). The prognostic impact of patient related covariates on the GOS was analysed using logistic regression analysis. Results: 49 out of 126 patients (38.9% ) died, 25 of them in the early postoperative period. Only 22/126 (17.5% ) had a favorable long term outcome (GOS > 3). Age > 65 years was significantly (p < 0.03, OR 3.6) associated with a higher risk for an unfavorable long term outcome (GOS ≤ 3). Treatment had no impact on outcome. Both techniques were highly effective in reducing the intracerebral blood volume by 75.8 ± .21.4% of the initial hematoma volume in frame- based and 64.8 ± 25.4 % in frameless stereotaxy within 2 days of rt- PA- therapy. Malpositioning of the catheter occurred more often in the frameless group (21.3 % vs. 9.4 % in the frame- based procedure) without gaining statistical significance. Conclusions: Frame- based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patients with a good clinical outcome remained limited especially in the elder subpopulation. Objectives: Comparison of two minimally invasive procedures for the treatment of intracerebral hemorrhage and subsequent lysis with regard to technical implications and clinical outcome of the patients. Methods: Retrospective analysis of 126 patients with spontaneous supratentorial intracerebral hemorrhage treated by frame-based (n = 53 ) or frameless (n = 75) hematoma aspiration and subsequent fibrinolysis with recombinant tissue plasminogen activator (rt-PA). Data were analyted for the whole group as well as for the two subsets of patients with regard to hematoma reduction, procedure-related complications , and the early and long term clinical outcome of the patients. Functional outcome was rated using the Glasgow Outcome Scale (GOS) and Barthel Index (median follow-up 178 weeks). The prognostic impact of patient related covariates on the GOS was analysed using logistic regression analysis. Results: 49 out of 126 patients (38.9%) died, 25 of them in the early postoperative period Age> 65 years was significantly (p <0.03, OR 3.6) associated with a higher risk for an unfavorable long term outcome (GOS ≤ 3 Both treatments were no effect on reducing the intracerebral blood volume by 75.8 ± .21.4% of the initial hematoma volume in frame-based and 64.8 ± 25.4% in frameless stereotaxy within 2 days of rt-PA - therapy. Malpositioning of the catheterization occurred more often in the frameless group (21.3% vs. 9.4% in the frame-based procedure) without gaining statistical significance. Conclusions: Frame- based and frameless stereotactic hematoma aspirations with subsequent fibrinolysis are effective in volume reduction of intracerebral hemorrhage with comparable clinical outcome. The frameless procedure is associated with a higher risk for malpositioning of the catheter. Despite effective hematoma reduction with both techniques, the percentage of patient s with a good clinical outcome remained limited especially especially in the elder subpopulation.