Abstract: Objective To compare the effectiveness and prognosis of endoscopic evacuation with traditional craniotomy in patients with hypertensive intracerebral hemorrhage (HICH). Methods A total of 164 consecutive patients with supratentorial hypertensive intracerebral hemorrhage admitted to the department of neurosurgery in our hospital from June 2009 to December 2013 were recruited into this study, and they were divided into endoscopy group (n=89) and craniotomy group (n=75) according to the surgical method. Clinical data about these patients were collected and comparisons of clinical outcome and long-term prognosis between these 2 groups were made. Results There were no significant differences of preoperative data between these two groups (P> 0.05). The evacuation rate of hematoma in endoscopy group (90.3%±5.6%) was significantly higher than that in craniotomy group (82.1%±8.3%) (P< 0.01). The operation time was 1.7±0.8 h for endoscopy group and 5.1±1.6 h for craniotomy group (P< 0.01). The average blood loss during operation was 94.4±99.1 ml for endoscopy group and 610.7±612.7 ml for craniotomy group (P< 0.01). Mean GCS score a week after surgery was 11.6±3.3 for endoscopy group and 8.4±4.5 for craniotomy group (P< 0.01). The average hospitalization time was 11.6±3.3 d for endoscopy group and 8.4±4.5 d for craniotomy group (P< 0.05). The mean Modified Rankin Scales (mRS) of 6-month follow-up was 3.2±1.8 for endoscopy group and 4.1±1.6 for craniotomy group (P< 0.05). Patients in endoscopy group got a better prognosis than patients in craniotomy group. Conclusion Endoscopic evacuation is a technically feasible, minimally invasive and highly efficient technique for the management of hypertensive intracerebral hemorrhage. Endoscopic surgery can improve the outcome and prognosis of patients with supratentorial hypertensive intracerebral hemorrhage.