Objective To retrospectively analyze the operating points and effect of microsurgery through the transsylvian approach via a small bone window combined with medical adhesive for repairing skull in the treatment of hypertensive basal ganglia hemorrhage (HBGH).Methods A retrospective analysis was performed on 31 patients with HBGH admitted from June 2010 to May 2014. These patients underwent microsurgery through the transsylvian approach via a small bone window to remove hematoma. The skull fragments and bone chips were remodeled according to the original shape with medical adhesive after operation.Results All patients survived. The hematoma clearance rate was over 90% in 26 patients and 70%-90% in 5 patients. The brain CT re-examinations at 1 and 6 months after operation showed that the skull was in good shape, skull bulging and depression and compression of the brain were not observed, and scalp hydrops was not found. As for the Activities of Daily Living scores, there were 11 grade I cases, 15 grade II cases, 4 grade III cases, and 1 grade IV case at 6 months after operation.Conclusions Treated with microsurgery through the transsylvian approach via a small bone window combined with medical adhesive, HBGH patients have high hematoma clearance rate, good postoperative rehabilitation, few postoperative complications, and good skull shape. This surgical procedure has low cost and easy operation, and is suitable for use in primary hospitals with less advanced equipment.