Hypertensive cerebral hemorrhage should be treated early once it is diagnosed. So how should it be treated? There are currently two approaches: medical treatment or surgical treatment. Which method has better results was debated in the early days. With the introduction of CT, the diagnosis of hypertensive cerebral hemorrhage is fast and accurate, and its bleeding site, bleeding volume, breaking into the ventricles, degree of cerebral edema, midline structure displacement and dynamic changes in the skull after bleeding can be directly obtained, which provides an important basis for choosing conservative internal hand treatment or surgical treatment. For those with less bleeding, medical treatment can be taken, mainly including absolute bed rest, sedation and stabilization of blood pressure, application of dehydrating drugs and hemostatic drugs, maintaining water and electrolyte balance, strengthening systemic support, and paying attention to keeping the airway unobstructed. Comatose patients should be meticulously cared for, and complications such as pneumonia, gastrointestinal bleeding, decubitus ulcers and deep vein thrombosis should be prevented and treated promptly. Surgery should be considered for patients with hematoma in the subcortex, the nucleus accumbens (hematoma volume greater than 30m1) or cerebellar hemisphere (hematoma volume greater than 10m1), those in a moderate or shallow coma, or those who have just shifted from consciousness to shallow coma, or those with early brain herniation. Surgical methods mainly include the following: (1) bone flap craniotomy for hematoma removal: it can remove hematoma and stop bleeding under direct vision. It is mostly used for those who have a large amount of bleeding, obvious occupying effect, and tendency to brain herniation or have formed brain herniation. (2) Stereotactic hematoma fragmentation and aspiration: accurate localization and small surgical trauma. Two methods are used to exclude the clot in the hematoma cavity: one is to break up the hematoma with auger and then aspirate it, but the effect of hemostasis and decompression is poor under direct vision, and the other is to dissolve the clotted hematoma with fibrinolytic drugs and drain it gradually. It is especially suitable for deep hemorrhage in the thalamus, brainstem and other areas with small bleeding volume. (3) Small bone window craniotomy hematoma removal: Our hospital currently uses the method of microscopic hematoma removal through the small bone window lateral fissure approach, which is less traumatic than bone flap craniotomy and can overcome the characteristics of stereotactic surgery that cannot stop hemorrhage under direct vision and poor decompression, and has achieved better economic and social benefits.