Objective To analyze and compare the therapeutic effects of minimally invasive neuroendoscopic surgery and craniotomy hematoma removal surgery in patients with hypertensive intracerebral hemorrhage. Methods A total of 46 patients with hypertensive intracerebral hemorrhage admitted from April 2021 to April 2024 were selected and divided into two groups according to different surgical methods. The control group （n=30） underwent craniotomy hematoma removal surgery, while the observation group （n=16） underwent minimally invasive neuroendoscopic surgery. Improvement in clinical efficacy, surgical time, intraoperative bleeding volume, and degree of neurological damage [assessed by the National Institutes of Health stroke scale （NIHSS）], and postoperative complications were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group （P<0.05）. The operation time was shorter and the intraoperative blood loss was less in the observation group than that in the control group （P<0.05）. There was no significant difference in the neurological function score （NIHSS） between the two groups before treatment （P>0.05）. After treatment, the NIHSS scores in both groups decreased compared to those before treatment, and the observation group had a lower score （P<0.05）. Compared with the control group, the observation group had a lower incidence of complications （P<0.05）. Conclusion Neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage can achieve the desired effect in a short period of time, with high safety and neurological function benefits. It is worth promoting and applying.