Objective To investigate the clinical effect of borehole drainage versus small bone window in the treatment of moderate basal ganglia hemorrhage evaluated by diffusion tensor imaging (DTI).Methods A retrospective analysis was performed for the clinical data of 58 patients with moderate (30~60 ml) basal ganglia hemorrhage. Among these patients, 28 were treated with borehole drainage (group A) and 30 were treated with small bone window microsurgery (group B). All the patients underwent DTI before surgery and at 2 weeks after surgery to obtain the fractional anisotropy (FA) score of bilateral corticospinal tracts (CSTs). The hematoma clearance rate, time of operation, intraoperative blood loss, rebleeding, intracranial infection, FA score of diseased side at 2 weeks after surgery, and Glasgow Outcome Scale (GOS) score at 3 months after surgery were observed.Results Group B had a significantly better hematoma clearance rate than group A (P<0.05), and there were no significant differences in rebleeding or intracranial infection between the two groups (P>0.05). Compared with group B, group A had significantly better results in the time of operation, intraoperative blood loss, FA score of diseased side at 2 weeks after surgery, and GOS score at 3 months after surgery (P<0.05).Conclusions DTI is an effective technique in early prognostic evaluation of basal ganglia hemorrhage. In the treatment of moderate basal ganglia hemorrhage, borehole drainage has small trauma, a shorter time of operation, rapid postoperative recovery, and a definite therapeutic effect.