Objective To compare the therapeutic effects difference of CT-monitored hard-directional channel technology and classical craniotomy method for elderly patients with hypertensive intracerebral hemorrhage classified as grade 3 to 5. Methods A retrospective analysis was conducted in 94 elderly patients with hypertensive intracerebral hemorrhage. According to operation mode, they were classified as craniotomy group(n=50) and mini-invasive operation group(n=44). The mortality rate and heavy deformity rate were compared between the two groups by chi square test. Results There was no significant difference in mortality rate between mini-invasive operation group and craniotomy group(32% vs 44%, P＞0.05). Activities of daily living(ADL) scale was used to assess the prognosis of the patients, and heavy deformity was defined as the fourth stage or the fifth stage assessed by ADL scale. There was significant difference in heavy deformity rate between mini-invasive operation group and craniotomy group (23% vs 50%, P＜0.05). Conclusion CT-monitored hard-directional channel technology can improve the prognosis of elderly patients with hypertensive intracerebral hemorrhage classified as grade 3 to 5, and this minimally invasive technique is convenient and effective.