〔Abstract〕Objective To observe the efficacy of minimally invasive surgery and conservative treatment of hypertensive intracerebral hemorrhage. Methods A total of 84 patients with hypertensive cerebral hemorrhage admitted to the First Affiliated Hospital of Henan University of Science and Technology from April 2019 to April 2020 were selected as the research objects. The patients were divided into control groups (42 cases: conservative treatment) and the observation group (42 cases: minimally invasive surgery), according to different treatment plans. the prognostic effects of two groups were compared. Results The total effective rate (97.62%) of the observation group was higher than that of the control group (80.95%), and the difference was statistically significant (P<0.05). The incidence of complications in the observation group (7.14%) was significantly lower than that in the control group (30.95%), and the difference was statistically significant (P < 0.05). The Scandinavian Stroke Scale (SSS) scores of the patients in the observation group were lower than those in the control group when they returned 3 months after discharge from the hospital, and the difference was statistically significant (P < 0.05). Conclusion The efficacy and safety of minimally invasive surgery in patients with hypertensive intracerebral hemorrhage are better than conservative treatment.