Background: Clinical applications of transsylvian transinsular (TS TI) approaches to hypertensive basal ganglia hemorrhages (HBGHs) have an enormous difference in functional independence rate. The aim of this study is to investigate the clinical efficacy of minipterional craniotomy with rostral TS TI approach to HBGH and compare functional independence rate with distal TS TI variant. Methods: From April 2017 to April 2019, eleven patients with symptomatic HBGH accepting minipterional craniotomies with rostral TS TI approaches were analyzed retrospectively. Results: The mean volume of preoperative hematoma was 57.08 ml with a 99.20% evacuation rate. Postoperative images revealed no rebleeding or newly developed hypodense lesion. Nine out of eleven patients got clear consciousness with functional independence at 3 months postoperatively. Conclusions: In comparison with distal TS TI approach, minipterional craniotomy with rostral TS TI approach to HBGH provides satisfactory outcome with higher functional independence rate.