Objective To investigate the effect of neuroendoscopic surgery on supratentorial hypertensive intracerebral hemorrhage. Methods Totally 42 patients with supratentorial hypertensive intracerebral hemorrhage treated in our center from Jan. to Dec. 2022 were retrospectively enrolled and divided into neuroendoscopic group (n=22) and craniotomy group (n=20) according to the treatment methods. The volume of residual hematoma, the rate of good prognosis 90 d after operation (modified Rankin scale score was 0-3), mortality, and complication incidence were compared between the 2 groups. Results The proportion of patients with postoperative residual hematoma less than 15 mL in the neuroendoscopic group (77.3 %, 17/22) was significantly higher than that in the craniotomy group (35.0 %, 7/20; P=0.022). In the neuroendoscopic group and craniotomy group, 14 (63.6 %) patients and 4 (20.0 %) patients had good prognoses 90 d after operation, respectively, with significant difference (P<0.001). The incidence of postoperative rebleeding was significantly lower in the neuroendoscopy group (4.5 %, 1/22) than that in the craniotomy group (5.0 %, 1/20; P=0.001). The incidence of postoperative pulmonary infection in both groups was 100 %, without significant difference (P=1.000). The 90 d mortality was significantly lower in the neuroendoscopic group (13.6 %, 3/22) than that in the craniotomy group (30.0. Conclusion, 6/20; P<0.001). Conclusion Neuroendoscopic surgery can improve the hematoma clearance rate, reduce complication incidence and mortality, and improve the prognosis of patients.