Objective To investigate the clinical efficacy of CT localization of intracranial hematoma minimally invasive surgery for the treatment of hypertensive cerebral hemorrhage. Methods 122 cases of elderly patients with cerebral hemorrhage were randomly divided into the control group(n=59) and the observation group (n = 63) according to the method of treatment. The control group were given conservative treatment, and the observation group were given CT positioning minimally invasive surgery for the treatment of intracranial hematoma. The clinical efficacy, ADL score, the hematoma volume before and after treatment, after treatment GCS score and CSS scores were compared. Results (1) After treatment, the total effective rate of observation group was 88.89%, significantly higher (74.38%) (P<0.05)than the contrao group; (2) the observation group therapy for stage I ADL score was significantly higher than the proportion of patients in the control group (P<0.05); (3) after treatment hematoma were significantly less than before treatment, hematoma after treatment and observation group was significantly lower than in the control group (P<0.05); (4) after treatment GCS and CSS scores were significantly higher than before treatment, group therapy and observation scores were significantly above the control group after treatment (P<0.05). Conclusion The clinical efficacy of CT localization of intracranial hematoma minimally invasive treatment of elderly hypertensive cerebral hemorrhage was significant, and could be promoted and applied.