Three cases of fulminant hypertensive intracerebral hematoma with volumes of 100 ml or more are reported.<BR>Superacute evacuation was accomplished under local anesthesia within three hours of ictus. In all cases, the results proved very favorable.<BR>On admission to our service, all three cases showed mydriasis, decerebrate limb posture and respiratory distress, suggesting tentorial herniation. Immediate hematoma cavity drainage was performed under local anesthesia and approximately 30 to 40% of the hematoma was manually evacuated. Evacuation of the residual hematoma was completed by infusing 6, 000 i.u. of urokinase solution into the hematoma cavity every 6 hours. Immediately after the initial aspiration, all of the cases showed improvement in respiration while level of consciousness also increased from somnolence to stupor. There was no incidence of rebleeding.<BR>One patient, a 70-year-old female with a left-sided intracerebral hemorrhage, died from aggravated pulmonary cancer two months after the surgery. Yet, she was alert until just before her death, although she suffered from motor aphasia.<BR>Another case, a 46-year-old male with a right-sided intracerebral hemorrhage, recovered to the point he could stand and walk with assistance within one month after the surgery. Now, five months postoperatively, he is leading a significant home life despite persistant paralysis in his left upper limb.<BR>The third case, a 72-year-old male with a right-sided hemorrhage, who had already suffered from a previous left putaminal hemorrhage 5 years before the present hematoma, remains. Slightly apathetic with left hemiparesis 4 months postoperatively.<BR>Experiences with these cases suggests that, even in fulminant intracerebral hemorrhage, evacuation of the hematoma in the superacute state may save life or even assure the patient a significant survival. In addition, this surgery can be carried out under local anesthesia without complicated stereotactic equipment. Thus, we can say that superacute evacuation is a simple and valuable technique for hypertensive intracerebral hemorrhage.