Unlike traditional neurosurgical techniques where the surgical site cannot be directly observed during the procedure, does puncture increase the risk of bleeding in the treatment of cerebral hemorrhage? How does it compare with conventional craniotomy? For this reason, we treated more than 30 consecutive patients with cerebral hemorrhage in the basal ganglia region of hypertension using a simple transfrontal approach with directional puncture and compared them with 50 patients treated with craniotomy in our department at the same time. Both groups were patients with cerebral hemorrhage in the range of 30 to 90 ml who had not yet herniated, and there were no differences in patient age or timing of surgery. It was found that the operating time of puncture was significantly shorter than that of craniotomy, and the operative mortality rate, postoperative rebleeding rate, reoperation rate, incidence of various postoperative complications (intracranial infection, pulmonary infection, epilepsy, hydrocephalus, etc.), hospitalization time, and hospitalization cost were significantly lower than those of craniotomy, while the patient prognosis was better than that of craniotomy. Therefore, for patients with cerebral hemorrhage in the basal ganglia region with moderate hematoma volume and no brain herniation, puncture is the preferred surgical procedure.