Abstract: Objective There was no golden standard for the treatment of hypertensive basal ganglia hemorrhage.The present study was to compare the clinical efficacy of minimally invasive surgical procedures combined with urokinase and craniotomy hematoma evacuation in patients with hypertensive basal ganglia hemorrhage and to provide basis for treatment of hypertensive basal ganglia hemorrhage. Methods From January,2014 to June,2016,126 cases of hypertensive basal ganglia hemorrhage in our hospital were prospectively collected.The patients were randomly divided into study group and control group with 63 cases in each group.The study group received minimally invasive surgery combined with urokinase (10 000 U/times),while the control group underwent craniotomy hematoma evacuation.The main outcome measures included the operation time,Glasgow coma score (0,1 and 14 days),hematoma clearance rate,organ failure,re-bleeding rate,intracranial infection,pulmonary infection,hospitalization time and 28-days mortality. Results There was no significant difference between the two groups in Glasgow coma score (8.52±1.78 vs.8.40±1.74,t=0.335,P=0.739) before the operation.But compared with the control group,at the first day and at the 14-days after the operation,patients in the study group got significant higher levels of Glasgow coma score[(11.06±1.94 vs.10.04±2.08,t=2.584,P=0.011) and (13.60±1.19 vs.11.90±1.87,t=5.500,P<0.001)].There was no significant difference in the rate of hematoma clearance between the two groups (93.65±7.56 vs.94.11±5.32%,t=0.375,P=0.832).But compared with the control group,the operation time of the study group was significantly shorter (135.90±17.41 vs.149.39±19.14 min,t=3.757,P<0.001).When compared with the control group,the hospitalization time of the study group was significantly shorter (21.45±5.67 vs.25.67±7.45 d,t=3.148,P<0.001).There were no significant differences between the two groups in 28-days mortality,organ failure,re-bleeding,intracranial infection and pulmonary infection between the two groups (P>0.05). Conclusion Minimally invasive surgery combined with urokinase in the treatment of basal ganglia hemorrhage is helpful to promote the recovery of neurological function,and active a good postoperative recovery.