To the Editor: Shao et al1 describe an innovative method in which they used an endoscopic side-cutting aspiration device to evacuate the intracerebral hematoma (ICH) with good results. Many recent multiple trials have established the definite role of minimally invasive surgical management of basal ganglia and deep seated ICH.2 European, Japanese, and Korean guidelines support the surgical management of patients with deep bruising and mass effect.3-6 Based on premises of less damage to healthy tissue and maximum possible evacuation, minimally invasive techniques have resumed the role of neurosurgery in ICH. The use of endoscopic techniques has demonstrated its successful utility in the management of ICH.6 One of the key aspects in the minimally invasive approach is the performance of the procedure after stabilization of the clot. We highlight the necessity of knowing patient's coagulation status prior to the intervention. Usually hematomas keep growing within the first 20 h in 38% of cases. On the other hand, intraoperatively, the device used by the authors facilitates the procedure by controlling the aspiration. The stabilized clot requires gentle aspiration and, eventually, strong aspiration would restart bleeding already controlled by the patient's hemostasis. This article1 shows usefulness of a side cutting aspiration device rather than simple aspiration one for the evacuation of ICH without causing collateral damage. It remains imperative to ask if complete evacuation of the ICH is necessary or the part near to the small perforators or lenticulostriate should be left for the best possible outcome. It has been noted earlier that complete evacuation may counter the functional recovery by causing damage to the deep perforators in the close vicinity of the inner side of the clot. A side cutting aspiration technique may fracture the clot and remove it in piecemeal, but its overzealous use might lead to injury to those perforators to a greater extent. Not only the device, but the vigilant use of the device at the different locations of the clot significantly impact the functional outcome of the patient. Again, it depends on the time since bleed and the coagulation status of the patient. A formed hematoma might be more difficult to remove than a fresh bleed and it may affect the outcome. Another highlight of the current article is the lesser need of the instrument withdrawal from the field contrary to the conventional aspiration device as this instrument can break and aspirate simultaneously. This not only increase the surgical ease but also decrease the operation time. The index case is one of the scenarios of the presentation with ICH and the outcome might be variable depending on the other confounding variables such as age of the clot, coagulation status, location, and the volume of the bleed. Future clinical trials with the BrainPath (NICO corporation, Indianapolis, Indiana) are required to confirm potential benefits of pure endoscopic techniques in the management of ICH and its impact on improving neurological outcomes. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.