The present study investigated the therapeutic effects and indications of keyhole transsylvian approach (KTA) in the treatment of hypertensive intracerebral hemorrhage (HICH). Clinical data of 65 cases of HICH were retrospectively analyzed. All the patients were treated by open surgical evacuation either through KTA (KTA group) or through conventional craniotomy approach (CCA group). The operative time, intraoperative bleeding quantity, the length of hospitalization, mortality, and favorable outcome were compared between the 2 groups. Compared with the CCA group, the KTA group had smaller bleeding quantity and shorter length of hospitalization. Favorable outcome at 3 months after admission was higher in the KTA group than that in the CCA group. The present study suggests that treatment of HICH through KTA is a practical and effective surgical procedure.