The difference between the results of the two groups, in the present series, are not statistically significant. Probably a larger number of patients in each group may give a definitive answer. It can be concluded that, in this series, the results of emergency surgery were comparable to those of planned early surgery. Results in grades IV and V continue to be dismal. We recorded a good outcome in only 9% of all patients admitted in grade IV. Bailes et al,[23] have identified a group of patients in, grades IV and V, who could benefit from emergency surgery. They reported a good outcome in 54.3% of such patients at 3 months, if the preoperative scan did not show evidence of irreversible brain damage (massive cerebral infarction with midline shift or large basal ganglia or brain stem haematomas), and the intracranial pressure was controllable with a ventriculostomy.