Abstract： Objective To explore the therapeutic efficacy, safety and complication incidence of microsurgical craniectomy for hypertensive intracerebral hemorrhage. Methods 105 patients with hypertensive intracerebral hemorrhage (the bleeding volume was 30-80 mL) were randomly divided into medical treatment (n=50) and microsurgical craniectomy (n=55). Outcomes were evaluated including patients' neurological functional deficiency scores 21 d after treatment, curative effect, complication incidence and mortality within 6 months. Results The patients' neurological functional deficiency scores in surgical treatment group were significantly superior to those in the medical treatment group(t=4.710, P=-0.000); the effect of surgical treatment was significantly superior to that in the control group(U=927.500 ,P=0.003); in the surgical treatment group, the complication incidence was lower than that of the control group significantly (χ2=8.935 ,P=0.003); the mortality in surgical group was 44.0%, which was lower than 23.6% in the control group in 6 months after treatment (χ2=4.014,P=0.045).Conclusion Microsurgical craniectomy, which can depress the mortality and the complication incidence and elevate the life level of patients, is an effective treatment method for the patients with basal nucle ihypertensive intracerebral hemorrhage (volume of 30-80 mL).