Objective To compare the efficacy of soft-channel puncture guided by computed tomography (CT) and minimally invasive craniotomy with a small bone window for the treatment of basal ganglia hemorrhage. Methods A total of 266 cases of basal ganglia hemorrhage with a blood loss of 20-40 ml were enrolled in this study. Of the 266 cases, 208 underwent soft-channel puncture of the hematoma cavity guided by CT (puncture group) and 58 underwent minimally invasive craniotomy (craniotomy group). The following indices were compared between the two groups:length of hospital stay, state of coma in cerebral edema stage, rebleeding incidence, and outcome. Results There were no significant differences in mean length of hospital stay, reduction in Glasgow Coma Scale score at 3 days after admission, and rebleeding incidence between the puncture group and the craniotomy group (11.53±0.418 days vs 11.30±0.778 days, P>0.05; 1.53±0.160 vs 1.48±0.232, P>0.05; 1.92% vs 1.72%, P>0.05). The puncture group had a significantly greater improvement in National Institutes of Health Stroke Scale score at discharge than the craniotomy group (2.98±0.247 vs 2.05±0.186, P<0.05). Conclusions For patients with moderate cerebral hemorrhage in the basal ganglia, puncture of the hematoma cavity leads to better prognosis compared with minimally invasive craniotomy.