Objective To compare the clinical efficacy of trepanation and drainage with small bone window craniotomy microsurgical technique in the treatment of hypertensive cerebral hemorrhage in basal ganglia. Methods A total of 126 hypertensive patients with basal ganglia hemorrhage from 2006 to 2012 undergoing surgical treatment were retrospec-tively analyzed, the amount of hematoma was between 30-60 mL. 60 patients received trepanation and drainage in the guidance of the CT scan were as drainage group, another 66 cases of patients received small bone window craniotomy with microscopes were as craniotomy group. The clinical efficacy of the two different methods in the treatment of hyper-tensive intracerebral hemorrhage were observed. Results The operative time of craniotomy was much more longer than drainage group (P<0.05). There was no difference in incidence of postoperative complications and mortality during hos-pitalization (P>0.05). The postoperative rebleeding in drilling drainage group was significantly higher than the cran-iotomy group. The 3-6 months discharge follow-up showed that there was no difference in the activities of daily living (ADL) in craniotomy group and drill drainage group (P>0.05). But mild disabilities+no dysfunction group of craniotomy group (86.4%), which was higher than that of drainage group (80.0%) (P<0.05). Conclusion Compare with drilling drainage skills in treating hemorrhagic patients with medium hematoma, small bone window craniotomy is a safe and efficient surgical procedure.