Objective To compare the clinical effect of traditional craniotomy, small bone flap craniotomy, and minimally invasive drilling and drainage in the treatment of moderate supratentorial hypertensive intracerebral hemorrhage.Methods Clinical data were collected from 93 patients with hypertensive intracerebral hemorrhage, and according to the surgical procedure, they were divided into traditional craniotomy group (group A with 33 patients), small bone flap craniotomy group (group B with 29 patients), and minimally invasive drilling and drainage group (group C with 31 patients). The three groups were compared in terms of baseline conditions, surgical conditions, and prognosis.Results There were no significant differences between the three groups in sex, age, systolic pressure on admission, preoperative GCS score, preoperative hematoma volume, GCS score on days 3 and 7 after surgery, rebleeding, intracranial infection, mortality rate, and mRS index at 6 months after surgery (P>0.05). Groups A and B had had a significantly better hematoma clearance rate than group C (P<0.001). Group C had the shortest time of operation and least intraoperative blood loss (P<0.001), and compared with group A, group C had significantly better GCS score on day 1 after surgery, duration of ICU stay, length of hospital stay, and pulmonary infection (P<0.05).Conclusions Minimally invasive drilling and drainage is safe and effective for patients with moderate supratentorial hypertensive intracerebral hemorrhage and thus holds promise for clinical application.