The key to surgical treatment of hypertensive cerebral hemorrhage is to achieve two things: “fast” and “complete”. There are two meanings of “fast”: the faster the patient is seen and the faster the surgery is started; the faster the hematoma is seen and the faster the surgery is started. “Complete” also has two meanings, one is that the hematoma removal should be complete; the other is that the intraoperative hemostasis should be complete. Compare several common surgical methods for treating hypertensive cerebral hemorrhage, including traditional craniotomy, “small bone window” microsurgery, “lock hole” surgery and neuroendoscopic surgery, all of which have one thing in common: the hematoma can be seen intraoperatively –The removal of hematoma and hemostasis can be done under direct visualization, microscope or fluoroscope, so it can be done “fully”. In terms of “fast”, these modalities are “fast” in that they can be used for patients who are ready to start surgery immediately after diagnosis, but they are “fast” in terms of the time between the determination of surgery and the start of surgery (i.e., preoperative preparation time), and the time between the start of surgery and seeing the hematoma. This is because, first, their preoperative preparations are tedious, including preoperative assessment of the patient’s status, skin preparation, blood pooling, routine laboratory tests, imaging, talking with the family and signing, deployment of operating rooms and nurses, preparation of special surgical equipment, and general anesthesia. For example, in my specialized hospital in the brain department, our average preoperative preparation time is about 2 to 3 hours. Secondly, they are complicated to operate. Even for a skilled surgeon, it takes at least 45 minutes to perform a traditional craniotomy from the time the skin is cut to the time the hematoma is seen, whereas for “small bone window”, “locking hole” and neuroendoscopic surgery, the operation time is shorter due to the small incision. However, the time saved is offset by the placement and commissioning of specialized equipment. Minimally invasive borehole drainage surgery is easy to be accepted by the patient’s family because of its small damage, low cost, and low preoperative status requirements plus the absence of general anesthesia, and it requires simple equipment and no special requirements for the operating room and personnel, thus saving a lot of time in preoperative preparation. What’s more, the operation is simple, and it takes only ten minutes (9 minutes and 40 seconds in the author’s record) from the time the skin is cut to the time the tube is placed and the hematoma is aspirated, so in terms of “speed”, drilling and drainage is undoubtedly superior to several other surgical methods. However, since drilling is only a simple internal tube into the hematoma cavity, it is impossible to completely remove the hematoma at one time, and requires postoperative injection of urokinase to dissolve the blood clot, which usually takes 2 to 3 days. So in the word “all” the borehole drainage is again a complete failure. These two defects lead to a very narrow indication for borehole drainage, which is only suitable for patients with mild bleeding of 25 to 45 ml, and for the safety of the operation, it is often necessary to wait until 24 hours after the onset of the disease before scheduling the operation. From this point on, “fast” is also discounted. So is there a way to combine the advantages of these surgical methods to achieve both “fast” and “complete”? After a period of clinical exploration, I found that the combination of transfrontal drilling and drainage under local anesthesia and transtemporal “small bone window” craniotomy under general anesthesia is a perfect solution. The combination of these two procedures is a strong combination, and they can complement each other’s strengths and weaknesses. Firstly, both procedures are minimally invasive and have the advantages of less damage, faster recovery and no secondary surgery to repair the skull. Secondly, transtemporal craniotomy makes up for the shortcomings of incomplete removal of hematoma and incomplete hemostasis of drilled drainage, so that drilled drainage no longer needs to wait for 24 hours and is no longer limited to patients with a small amount of bleeding, which greatly expands the scope of application of drilled drainage. Before transtemporal craniotomy, transfrontal borehole drainage to remove part of the hematoma can effectively decompress and prevent the occurrence of acute cerebral bulge and brain tissue herniation due to small bone window and high cranial pressure; at the same time, the drainage tube is retained after surgery, even if there is a small amount of bleeding in the postoperative area, it will be drained out in time to avoid secondary craniotomy, and a small drainage tube plays the role of escort for a complex surgery. So far the author has completed more than 60 cases of this type of surgery with good results, none of which had intraoperative brain bulge and late hematoma after surgery. Moreover, the average postoperative recovery time and the incidence of complications are significantly better than those of traditional craniotomy.