Objective To explore the clinical values of minimally invasive puncture and drainage of hematoma and traditional craniotomy in the treatment of hypertensive intracerebral hemorrhage （HIH）. Methods A total of 41 patients with HIH treated with minimally invasive puncture and drainage of hematoma from January 2017 to December 2022 were selected as Mi group, and at the same time, 46 patients with HIH treated with traditional craniotomy were selected as Tc group. The hematoma clearance rate, nerve injury, self-care ability, quality of life, and adverse reactions of the two groups were compared. Results There was no significant difference in the clearance rate of hematoma between the two groups （P>0.05）. The incidence of adverse reactions in the Mi group was significantly lower than that in the Tc group （P<0.05）. The National Institutes of Health stroke scale （NIHSS）, activities of daily living （ADL）, and short form health survey （SF-36） scores were not significantly different between the two groups before operation （P>0.05）, but were significantly improved in the two groups after operation （P<0.05）, and the scores of NIHSS, ADL, and SF-36 in the Mi group were significantly better than those in the Tc group （P<0.05）. Conclusion Compared with traditional craniotomy, minimally invasive puncture and drainage of hematoma can significantly reduce the incidence of postoperative complications and improve the long-term prognosis of patients with HIH.