Objective To compare the effects and prognosis of craniotomy evacuation of hematoma and hard tunnel minimally invasive perforation for hypertensive basal ganglia hemorrhage ( HBGH ) . Methods A total of 192 patients with HBGH from January 2005 to December 2013 were retrospectively reviewed , including 96 cases of craniotomy evacuation of hematoma and 96 cases of minimally invasive puncture drainage .No significant differences were found in age , gender, lesion side,and Glasgow coma scale between the two groups ( P >0.05 ).The intraoperative bleeding volume , postoperative residual hematoma , operation time, hospitalization duration , and the postoperative clinical curative effects at 3 weeks and 6 months after operation were compared between the two groups . Results As compared with the craniotomy group , the operation time of the hard tunnel minimally invasive perforation group was significantly shorter [31 (24 -39) min vs.152 (131 -170) min, Z =-11.975, P =0.000], the intraoperative blood loss was significantly less [0 ml in 30 cases and <5 ml in 66 cases vs.(332.4 ±20.2) ml],and the hospitalization duration was significantly shorter [14 (10-17) d vs.64 (44-75) d, Z=-44.217, P=0.000].However, the postoperative residual hematoma was larger in the hard tunnel minimally invasive perforation group than in the craniotomy group [13 (8-17) ml vs.7 (4-12) ml, Z=-11.573, P=0.000].At the third week of postoperation , the Glasgow Outcome Scale in the hard tunnel minimally invasive perforation group was higher [4 (2-4) vs.3 (1-4), Z=-8.215, P=0.000], and the Barthel Index was higher [(59.9 ±4.5) vs.(54.9 ±4.9), t=7.370, P=0.000] than the craniotomy group.At sixth month postoperation, the Glasgow outcome scale in the hard tunnel minimally invasive perforation group was higher [3 (2-4) vs.2 (1-4), Z=-7.448, P=0.000], and the Barthel Index was higher [(64.3 ±8.4) vs.(59.7 ±6.8), t=4.156, P=0.000].No significant differences in mortality were found between the two groups (P >0.05). Conclusion Minimally invasive hard tunnel puncture drainage is significantly superior to craniotomy evacuation of hematoma in the treatment of HBGH and deserves to be promoted for clinical performance .