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Introduction Cerebellar intracerebral hemorrhages (ICH) are a devastating subset representing about 10% of all ICH. While surgical management is indicated in select cases, it is often followed by long-term neurological complications. In addition, guidelines for the management of cerebellar ICH vary as there is a lack of data from controlled studies. We evaluated the differences in outcomes between treatment strategies for cerebellar ICH, along with two examples of cerebellar minimally invasive hematoma evacuations (MIS).Methods We performed a single-center retrospective review of consecutive patients with cerebellar ICH from March 2018 to February 2026. Baseline clinical and radiographic variables were collected, including history of anticoagulation/antiplatelet use, ICH score, hospital length of stay, discharge disposition, discharge modified Rankin scale (mRS), surgical intervention (hematoma evacuation), length of time of the operation, and surgical complications. ICH volume was calculated by the ABC/2 method. Multivariate analysis evaluated predictors of hospital length of stay and mortality.Results A total of 67 patients were included in the analysis, of which median age was 68 years (IQR 56.5-79.5), 52.2% of patients were male, 64.2% had a history of hypertension, and the median presenting systolic blood pressure was 173 mmHg (IQR 144.5-201.5). 42 patients (62.7%) had brainstem compression, 32 patients (47.8%) had intraventricular hemorrhage (IVH), and 39 patients had hydrocephalus (58.2%). In an adjusted model, age (OR 1.007, 95% CI 1.001-1.013, p = 0.021) and initial ICH volume (OR 1.011, 95% CI 1.003-1.019, p = 0.006) were independently associated with increased odds of in-hospital mortality, whereas prehospital antiplatelet use (OR 0.625, 95% CI 0.493-0.793, p < 0.001) was associated with decreased odds of mortality. Surgical intervention (OR 2.810, 95% CI 1.491-5.244, p = 0.001) remains the only significant predictor of hospital length of stay. Treatment modality, however, did not affect discharge mRS (p = 0.705) or mortality (p = 1). Two patients underwent MIS evacuations. The average length of stay for these two patients was 32.3 days, and both patients were discharged to subacute rehabilitation facilities. The average evacuation percentage was 93.9% for MIS patients, as compared to 75.6% for patients who underwent traditional craniotomy.Conclusion Our data demonstrates that, while surgical intervention lengthens hospital stay, it does worsen mortality nor affect functional status at discharge. Minimally invasive surgery can be a promising treatment modality in cerebellar ICH evacuation, though randomized studies are necessary to evaluate its safety and effectiveness in this population.Disclosures J. Shin: None.