In The Lancet, David Mendelow and colleagues1 report the results of their second randomised STICH (STICH II) trial of early surgery compared with initial conservative treatment for patients with superficial lobar intracerebral haemorrhage. They included 597 patients from 78 centres in 27 countries; 589 of 597 patients were available for follow-up at 6 months. The investigators did not find significant evidence to support the hypothesis that early surgery improves outcome in conscious patients with a superficial intracerebral haemorrhage with a volume of 10–100 mL, and found no evidence of additional intraventricular haemorrhage.