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Spontaneous supratentorial intracerebral hemorrhage (SSICH) is a critical condition with a high risk of morbidity and mortality, often requiring prompt intervention. Various surgical approaches have been employed to enhance outcomes; however, their comparative effectiveness remains uncertain. Databases including PubMed, Cochrane Central, and ScienceDirect were searched from inception till February 2025 for Randomized controlled trials (RCTs) investigating neuroendoscopy (NE), stereotactic aspiration (SA), craniopuncture surgery (CP), craniotomy (CR), decompressive craniectomy (DC), and conservative medical treatment (CMT). A frequentist network meta-analysis was conducted using R version 4.2.1 and the "netmeta" package, employing the random effects model. Treatment ranking was performed using p-scores, and the risk of bias was assessed using the ROB 2.0 tool. Publication bias was evaluated visually through funnel plots and statistically through Egger's Regression test. The analysis included 25 RCTs involving 4,324 patients. Compared to CMT, NE (RR = 1.77, 95% CI: [1.43,2.20]; p < 0.0001), SA (RR = 1.65, 95%CI: [1.38,1.98]; p < 0.0001), and CR (RR = 1.26, 95%CI: [1.04,1.54]; p = 0.019) showed significant improvement in good functional outcome (GFO) and NE was ranked the best for functional improvement (p-score = 0.93). Mortality was significantly reduced in NE (RR = 0.67, 95%CI: [0.52,0.85]; p = 0.001), and CR (RR = 0.82, 95%CI: [0.69,0.98]; p = 0.028) compared to CMT. NE was considered the most optimal treatment for reducing mortality (p-score = 0.81). Compared to CMT, the risk of rebleeding and overall complications was not significantly different with the surgical interventions. NE, SA and CR significantly improved functional outcomes whereas NE and CR reduced mortality in patients with SSICH compared to CMT. NE may be the most optimal treatment for improving functional scores and mortality according to p-score ranking. Further, high-quality multicenter randomized clinical trials are required.