Objective To investigate the value of the spot sign on computed tomography angiography (CTA) and computed tomography perfusion (CTP) in selecting the surgical procedure of early-stage aspiration or craniotomy for patients with moderate basal ganglia hemorrhage.Methods A total of 221 patients with moderate basal ganglia hemorrhage (a bleeding volume of 30~60 ml) whose family members agreed to ultra-early surgical procedure were enrolled, and according to whether they were willing to undergo cranial CTA and CTP after admission, they were divided into experimental group (with 105 patients willing to undergo examination) and control group (with 116 patients unwilling to undergo examination). According to the positive or negative result of the spot sign on CTA or CTP for the patients in the experimental group, 32 patients with a positive result were treated with craniotomy and 73 with a negative result were treated with aspiration. According to the surgical procedure selected by family members after informed consent was given, the control group was further divided into craniotomy subgroup with 39 patients and aspiration subgroup with 77 patients. Clinical outcome was compared between the experimental group and the control group to evaluate the value of the spot sign on CTA and CTP in selecting ultra-early surgical procedure for moderate basal ganglia hemorrhage.Results There were significant differences between the experimental group and the control group in response rate (77.1% vs 52.6%, P<0.05), rate of postoperative hematoma enlargement (3.8% vs 18.1%, P<0.05), mortality rate (3.8% vs 15.6%, P<0.05), and intracranial infection rate (2.9% vs 12.1%, P<0.05).Conclusions Surgical procedure for moderate basal ganglia hemorrhage selected based on a combination of the spot sign on CTA and CTP can significantly improve patients' prognosis.