Objective To compare the clinical efficacy of neuroendoscopy and small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage. Methods Studies comparing the efficacy of neuroendoscopy and small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage between 2008 to 2018 were selected from Wanfang Data, VIP, and PubMed. A meta-analysis was performed using the RevMan 5.3 software. Results A total of 4 randomized controlled studies and 6 case-control studies were included. Of the 965 cases, 493 were in the neuroendoscopy group and 472 were in the small bone window group. The meta-analysis of these studies showed that the neuroendoscopy group had a significantly higher hematoma evacuation rate (standardized mean difference[SMD]=14.20, 95% confidence interval[CI]:8.48-19.92), significantly less intraoperative bleeding (SMD=-215.06, 95%CI:-255.41 to -174.71), a significantly shorter operation time (SMD=-96.63, 95%CI:-114.24 to -79.01), significantly shorter ICU stay (odds ratio[OR]=-5.91, 95%CI:-6.26 to -5.57), and fewer postoperative complications (OR=0.28, 95%CI:0.19-0.43) than the small bone window group (all P<0.05). Furthermore, compared with the small bone window group, the neuroendoscopy group had a significantly higher good recovery rate at 6 months post-surgery (OR=2.02, 95%CI:1.54-2.66) and a significantly lower mortality rate (OR=0.32, 95%CI:0.16-0.62) (both P<0.05). Conclusions Neuroendoscopy has better prognosis, lower mortality, and superior efficacy than small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage. Furthermore, neuroendoscopy results in higher hematoma evacuation rate, less intraoperative blood loss, shorter operation time, shorter ICU stay, and fewer postoperative complications, and therefore holds promise for clinical application.