Objective To study the clinical efficacy and safety of neuroendoscopic surgery in the treat⁃ ment of severe intraventricular hemorrhage. Methods From January 2019 to May 2021，96 patients with severe intraventricular hemorrhage were treated in the department of neurosurgery in Anqing Hospital，Anhui Medical University，49 of them treated with neuroendoscopic surgery and 47 with simple extraventricular drainage. The two groups were compared in terms of hospital stay，postoperative GCS score，postoperative clearance of hematoma， prognosis and complications. Results There were statistically significant differences in the hematoma clearance rate，postoperative hospital stay，intracranial infection and GCS score on the 1st and 14th day after surgery between the two group（P < 0.05）. After 6 months follow⁃up，the prognosis of 35 cases（71.42%）in the neuroendoscopy group was good by the ADL score and there were 5 cases of hydrocephalus in the group（10.20%）；while the prognosis of18 cases（38.29%）in the extraventricular drainage group was good and there were19 cases（40.42%）of hydro⁃ cephalus in the group. The rate of good prognosis and incidence of hydrocephalus in the neuroendoscopy group were significantly better than those in the extraventricular drainage group（P < 0.05）. Conclusion Neuroendoscopic surgery has good curative effect on severe intraventricular hemorrhage. It can improve the clinical prognosis and out⁃ come of patients，and is suitable for clinical promotion.