Objective To investigate the clinical effect of micro-bone window craniotomy in the treatment of patients with cerebellar hemorrhage and its effect on cognitive function and activities of daily living (ADL) after surgery.Methods A retrospective analysis was performed for the clinical data of 51 patients with cerebellar hemorrhage who underwent surgical treatment in our department from August 2012 to June 2018, and their Glasgow Coma Scale (GCS) score ranged from 9 to 12 points. According to the surgical plan, the patients were divided into traditional craniotomy group with 26 patients and micro-bone window craniotomy group with 25 patients. The two groups were compared in terms of time of operation, intraoperative blood loss, time of postoperative drainage under the scalp, and length of hospital stay, as well as Mini-Mental State Examination (MMSE) score and Barthel Index (BI) at 1, 2, and 3 months after surgery.Results Compared with the traditional craniotomy group, the micro-bone window craniotomy group had significantly better time of operation, intraoperative blood loss, time of postoperative drainage under the scalp, and length of hospital stay (P<0.05). There were no significant differences in MMSE score and BI at 1, 2, and 3 months after surgery between the two groups (P>0.05).Conclusions In patients with cerebellar hemorrhage and a GCS score of 9-12 points, micro-bone window craniotomy has the advantages of a short time of operation, low intraoperative blood loss, and a short length of hospital stay. However, there is no significant difference between traditional craniotomy and micro-bone window craniotomy in the recovery of cognitive function and ADL after surgery.