Objective: To investigate the clinical efficacy of small bone window craniotomy and large bone flap craniotomy in the treatment of hypertensive intracerebral hemorrhage. Methods: A total of 100 cases with hypertensive intracerebral hemorrhage from September 2015 to September 2016 in Suzhou First People’s Hospital were included. The minimally invasive group (50 cases) received minimally invasive small bone flap craniectomy, and the conventional group (50 cases)received traditional large bone flap craniectomy. Compare the perioperative condition, clinical efficacy, neurological deficits and living capacity after 6 months postoperatively, and complications, rebleeding, hematoma residue during the 1-years’follow-up period between the two groups. Results: The diameter of incision, bleeding, duration of operation, bleeding free rate, duration of ICU stay and duration of hospital stay in the general ward were better than those in the conventional group (P<0.05). The total effective rate of minimally invasive group was higher than that of routine group (P<0.05). There was no significant difference of complications and residual hematoma between the two groups (P>0.05). And the rate rebleeding of minimally invasive group was lower than conventional group (P<0.05). The NIHSS score of the minimally invasive group was significantly lower than that of the conventional group (P<0.05). The ADL score of the minimally invasive group was significantly higher than that of the conventional group (P<0.05). Conclusion: Compared with the large bone flap craniotomy, the small bone window craniotomy had advantages in the treatment of hypertensive intracerebral hemorrhage such as less traumatic, faster postopearative recovery, better clinical efficacy, few complications. In a word, small bone window craniotomy is worthy to promotion.