Objective To discuss the diagnosis and microsurgical treatment of vascular malformation hemorrhage in the basal ganglia.Methods A retrospective analysis was performed on the clinical data of 12 patients with vascular malformation hemorrhage in the basal ganglia treated in our hospital from February 2011 to December 2014, including clinical and imaging data, operative findings, and pathological results.Results Ten patients underwent small bone window craniotomy, and 2 patients received large bone flap craniotomy. Abnormal vascular tissues were seen on the hematoma walls during the surgery, with no markedly large feeding arteries or draining veins. Postoperative pathological results showed 8 cases of arteriovenous malformations and 4 cases of cavernous hemangioma.Conclusions For patients with basal ganglia hemorrhage, the possibility of vascular malformations should be alerted, and differentiation should be performed before surgery. Most vascular malformations in this region are small, with no markedly large feeding arteries and draining veins. The resection of surrounding vascular mass with malformation needs more attention during surgery.