〔Abstract〕 Objective To explore the effect of minimally invasive hematoma removal on the complications and quality of life of elderly patients with hypertensive intracerebral hemorrhage (HICH). Methods 60 elderly patients diagnosed with HICH in Yangchun People's Hospital from July 2019 to June 2021 were selected and randomly divided into two groups: control group with 30 cases underwent craniotomy hematoma removal; Observation group with 30 cases were treated with minimally invasive hematoma removal. The evaluation indexes were activety of daily living scale (ADL) score, complication rate and total operative response rate. Results The ADL scores of patients in the observation group were higher than those in the control group at 3 and 6 months after operation, and the complication rate was lower than that in the control group (10.00% vs 33.33%) (P < 0.05). The total effective rate of surgery in the observation group (96.67%) was significantly higher than that in the control group (73.33%) (P < 0.05). The hematoma clearance rate of the observation group was higher than that of the control group (90.00% vs 53.33%) (P < 0.05). Conclusion Minimally invasive hematoma removal can improve the quality of life of elderly patients with HICH and reduce complications.