Objective To analyze the clinical effects of removal of hematoma under neuroendoscope on hypertensive cerebral hemorrhage and the potential factors affecting prognosis. Methods A total of 80 patients with hypertensive cerebral hemorrhage admitted from July 2020 to July 2023 were selected as study subjects. According to different surgical methods, they were divided into an endoscopic group （hematoma removal under neuroendoscopy） and a small bone window group （hematoma removal by small bone window craniotomy under microscope）, with 40 cases in each group. Operation time, intraoperative blood loss volume, hematoma clearance rate, and postoperative complication incidence were compared between the groups. Preoperative information and postoperative prognosis [Glasgow outcome scale （GOS） score], the degree of neurological impairment [neurological functional deficit score （NFDS）], and the ability of daily living [activities of daily living （ADL） score] were compared between the two groups. Logistic regression analysis was performed of factors affecting the prognosis of patients in the endoscopic group. Results The endoscopic group showed significantly lower operation time and intraoperative blood loss volume than the small bone window group （P<0.05）, significantly higher clearance rate of hematoma （P<0.05）, and significantly lower incidence of postoperative complications （P<0.05）. Before surgery, there was no significant difference in GOS, NFDS, and ADL scores between the two groups （P>0.05）. After surgery, the three indicators of the two groups were significantly changed, and the endoscopic group had significantly better results than the small bone window group （P<0.05）. The logistic analysis showed that hypertension history, blood loss volume, ventricle rupture or not, and GOS score before surgery were all risk factors affecting the prognosis of patients in the endoscopic group （P<0.05）. Conclusion The treatment of hypertensive intracerebral hemorrhage by removal of hematoma under neuroendoscope can significantly increase the removal rate of hematoma, shorten operation time, reduce the amount of intraoperative blood loss, reduce the occurrence of postoperative complications, improve prognosis and neurological function, and elevate the activities of daily living, so it can be used in clinical practice. Hypertension history, amount of blood loss, ventricle rupture or not, and GOS score before operation may be the risk factors affecting the prognosis of patients with intracerebral hematoma removal under neuroendoscopy.