Abstract: 【Abstract】Objective To evaluate the clinical value of midfrontal keyhole approach for treatment of severe intraventricular hematoma .Methods The clinical data of 21 cases of severe intraventricular hemorrhage through midfrontal keyhole approach were analyzed retrospectively. Results Evacuation of hematoma was satisfied in all cases. improved the GCS scores, intraventricular hemorrhage Graeb scores. Mian Complications after operation: diffuse brain swelling 1 case, cerebral vasospasm 3 cases, intracranial infection 1 case, pulmonary infection 7 case. According to COS, of 21 patients,5 were recovered well, 9 moderately disabled, 3 severely disabled, 1 vegetative and 3 died. Conclusions We can remove the hematoma through midfrontal keyhole approach, Restore the cerebrospinal fluid circulation , reduce the secondary brain damage, improve the prognosis of patients

Key words: severe intraventricular hemorrhage, microsuegery, via transcortial middle frontal gyrus approach