Objective To investigate the application of frameless stereotactic minimally invasive puncture combined with urokinase injection in the treatment of traumatic intracranial hematoma.Methods A retrospective analysis was performed to investigate the treatment outcomes of 37 patients with traumatic intracranial hematoma who received minimally invasive treatment from February 2012 to February 2013. Frameless stereotactic minimally invasive puncture and drainage using a disposable intracranial hematoma removal set were performed within 24 hours after traumatic intracranial hematoma was confirmed by CT scanning, and urokinase injection and blood drainage using the intracranial hematoma removal set were performed twice daily after operation.Results All the 37 patients were cured and discharged. Twenty-nine cases (73.38%) had a full recovery of physical activity, 6 cases (16.22%) had mild physical disability, and 2 cases (5.4%) had severe contralateral hemiplegia; 13 cases (35.14%) had aphasia, and other cases had a good recovery of language function. The length of hospital stay ranged from 7 to 18 days, with a mean of 10.7 days.Conclusions Stereotactic minimally invasive puncture has accurate positioning, positive efficacy, mild trauma, and few complications, and can reduce the economic burden of patients.