Objective: Decompressive hemicraniectomy with hematoma evacuation is life-saving and improves unfavorable outcomes. INTRODUCTION: Decompressive hemicraniectomy in enormous hemispheric areas of localized necrosis has been accounted for to bring down mortality and improve the ominous results. Hematoma volume is an amazing indicator of 30-day mortality in patients with intracerebral discharge (ICH). Hematoma volume adds to intracranial volume and may prompt unsafe rise of intracranial pressure. METHODS: This study was conducted at BMC/SPH, Quetta from Mar 2018 – Feb 2019. The 24 continual patients with hypertensive ICH treated with decompressive hemicraniectomy were evaluated. The information gathered included Glasgow Coma Scale (GCS) score at confirmation and before surgical procedure, ICH volume, ICH score and a clinical evaluating scale for ICH that precisely hazard stratifies patients in regards to 30-day mortality. RESULTS: Of the 42 patients with decompressive hemicraniectomy, 20(83.3%) survived to discharge; of those 20, 12 (60%) had good functional outcome, defined as a mRS of 0 to 3. The mean age was 49.8 years. 20 patients with an ICH score of 6, 18 (90%) survived to discharge, 8 (44%) had good functional outcome. Hematoma volume was 60 cm3 or greater 8 (50%) patients of whom had good functional outcome. CONCLUSION: Decompressive hemicraniectomy with hematoma evacuation is life-saving and improves unfavorable outcomes in a select group of young patients with large right hemispherical ICH.