There is controversy concerning the surgical indications for cerebral lobar hemorrhage secondary to amyloid angiopathy in the elderly. We encountered 14 patients with such a lesion, operated on 10 of them, and evaluated their clinical findings and surgical outcome. There were 7 males and 7 females, and their ages ranged from 66 to 87 years (mean age: 75.9 years). Consciousness, CT and surgical findings, and outcome were examined. Nine patients were alert or somnolent and five were semicomatose or comatose. The most common sites of the hemorrhages were the parietal lobe and occipital lobe, and the bleeding was massive, with volume of 28-120 ml. The hematomas were solitary and there had been no previous bleeding. They were evacuated thoroughly by open surgery, and there was difficulty in achieving hemostasis. The arteries in the involved cortex of 6 patients were positive for Congo red staining. There was no rebleeding postoperatively. Five of the six alert or somnolent patients with hematoma volume of 28-60 ml recovered clinically, and their outcome was good. One developed rebleeding four months later at a different site and became bed-ridden. Four of the patients who were semicomatose or comatose and whose hematoma volume 70-120 ml either died or became bed-ridden. Surgery may be indicated in patients with cerebral lobar hemorrhage if their consciousness level in good, but it would be of limited value in elderly patients whose underlying disorder is amyloid angiopathy.