Objective To investigate the treatment and prognosis of patients with cerebral hernia after intracerebral hemorrhage by puncture and drainage. Methods The clinical data of patients with recurrent cerebral hernia after cerebral hemorrhage puncture and drainage from September 2014 to December 2021 were retrospectively analyzed. Results 11 patients were treated by early hematoma aspiration and urokinase dissolution and drainage to remove the hematoma. After 6 months, ADL grade was 4 cases of grade II, 6 cases of grade III and 1 case of grade IV. 4 patients were transferred to standard decompressive craniectomy with mega-bone flap and microscopic hematoma evacuation. After 6 months, ADL grade was 2 cases of grade III, 1 case of grade IV and 1 case of grade v. Conclusion Early hematoma aspiration can be used as the first choice for patients with cerebral hernia caused by second hemorrhage after cerebral hemorrhage puncture and drainage, and craniotomy should be prepared.