Objective:To compare the effectiveness of minimally invasive puncture and conservative treatment for moderate to equal basal ganglia hemorrhage, and to analyze which treatment plan is superior.Method:A retrospective study was carried out on 65 patients who fulfilled the inclusion criteria. Based on the treatment plan, they were categorized into two groups: a minimally invasive puncture surgery group (surgical group) consisting of 39 patients, and a conservative treatment group comprising 26 patients. Key parameters such as hematoma volume, early GCS score, and NIHSS score were documented on the 1st, 3rd, and 7th days post-admission, and any serious complications during the hospital stay were examined. Three months post-discharge, the patients' outcomes were assessed using the Modified Rankin Scale score (mRS score).Results:The mean residual hematoma volume and hematoma clearance rate 3 days after operation in the surgical group were better than those in the conservative group, the early GCS and NIHSS scores in the surgical group were better than those in the conservative group (P<0.001), and the incidence of pulmonary infection in the surgical group was lower (P<0.001). The recovery rate (mRS score≤ 2) at 3 months after discharge was significantly better than that of the conservative treatment group (P<0.05), but there was no significant difference in mortality within 30 days (P=0.3430). Conclusion:Minimally invasive surgery for moderate to moderate basal ganglia hemorrhage is more effective than conservative treatment, and the prognosis and neurological function recovery of patients are better.