Abstract: Objective: To explore application and effectiveness of craniotomy with small bone flap for the early treatment of hypertensive intracerebral hemorrhage. Methods: Fifty-two patients with hypertensive intracerebral hemorrhage were underwent surgical treatment within 6 to 12 hours after bleeding. Small bone flap with diameters of 3 to 4 cm were made through 6cm vertical scalp incision,and then the hematomas in cavity were cleaned out through cortical ostomy along sulcus. After surgery,hematomas cavities were perfused with urokinase through drainage-tube to cleare up the residual hematoma. Results: Among the 52 patients,30 patients were good-recovery,8 patients were moderate-deficit,4 patients were severe-deficit,3 patients were persistent vegetative status,5 patients died,and 2 patients self-discharged. Conclusions: Craniotomy with small bone flap have merits of short operative time,slight trauma, rapid recovery and high cure rate,for the early treatment of hypertensive intracerebral hemorrhage,and is suitable to apply in primary hospital.