〔Abstract〕 Objective To explore the clinical effects of craniotomy for hematoma removal combined with bone flap decompression in the treatment of hypertensive cerebral hemorrhage. Methods A total of 96 patients with hypertensive cerebral hemorrhage admitted to the hospital between March 2016 and March 2019 were selected, and divided into observation group and control group according to the surgical method, with 48 cases in each group. Patients in the observation group were treated with craniotomy for hematoma removal combined with bone flap decompression, while patients in the control group were treated with craniotomy for hematoma removal alone. Surgical results and complications of the two groups were compared. Results On day 14 after surgery, the distribution of activity of daily living scale (ADLS) grades in the observation group was significantly better than that in the control group (P < 0.05). There was no statistically significant difference in the national institutes of health stroke scale (NIHSS) score between the two groups before surgery (P > 0.05). On day 14 after surgery, the NIHSS score of observation group was significantly lower than that of the control group (P < 0.05). The excellent and good rate of neurological function recovery in the observation group was significantly higher than that in the control group (P < 0.05), and the incidence of complications was significantly lower than that in the control group (P < 0.05). Conclusion Craniotomy for hematoma removal combined with bone flap decompression is effective in the treatment of hypertensive cerebral hemorrhage, which can significantly improve neurological deficit and ADL, and promote recovery. In addition, it is safe and effective.