Objective To compare the efficacy and prognosis of minimally invasive drilling drainage (MIDD) and small bone window cranial hematoma clearance (SBWCHC) in patients with moderate cerebral hemorrhage in hypertensive basal ganglia. Methods From May 2016 to May 2018,84 patients with moderate intracerebral hemorrhage in hypertensive basal ganglia were selected, who were treated in the Department of Neurosurgery of Xiangzhou People′s Hospital of Guangxi Province. The patients were rando-mized into the MIDD (study) group and the SBWCHC (control) group, with 42 in each group. The two groups were compared statistically in the operation time, intraoperative bleeding volume, hematoma clearance rate, postoperative complications, and rebleeding. Glasgow outcome score (GOS) and Glasgow coma score (GCS) at 3 weeks, activity of daily life (ADL) rating and mortality at 3 months were recorded. SPSS statistics 22.0 was used to analyze the data, and depending on data type, t test or Chi square test was used for the comparison between groups. Results Compared with control group, the operation time, amount of bleeding, incidence of pulmonary infection and gastrointestinal bleeding in the study group were significantly reduced (P<0.05). But no significant difference was observed between the two groups in the clearance rate of hematoma (P>0.05), GOS [(3.4±0.6) vs (3.1±0.9), P=0.347], and GCS [(11.6±1.3) vs (11.2±1.7), P=0.539] at 3 weeks, and fatality rate [4.76%(2/42) vs 2.38%(1/42), P=0.557] andADL excellence rate [78.57%(33/42) vs 88.09%(37/42), P=0.242] at 3 months. Conclusion Small bone window cranial hematoma clearance and minimally invasive drilling drainage are both effective in moderate cerebral hemorrhage in hypertensive basal ganglia and are able to effectively remove hematoma, but drilling drainage requires relatively shorter operation time and results in fewer complications, whose application is preferred.