Objective To compare effects of neuroendoscopy combined with lumbar cistern drainage and drilling drainage on hematoma clearance, postoperative complications and shortterm prognosis in patients with severe ventricular hemorrhage (SVH). Methods 282 patients with ventricular hemorrhage admitted to neurosurgery department of the hospital from December 2013 to December 2017 were retrospectively analyzed. According to different surgical methods, they were divided into two groups. The 130 patients in endoscopy group were treated with neuroendoscopy combined with lumbar cistern drainage, while 152 patients in drilling group were treated with drilling drainage. At the end of surgery, postoperative hematoma clearance rate, postoperative complications and shortterm prognosis were compared. Results The postoperative hospitalization time and intraoperative blood loss in endoscopy group were shorter than those in drilling group (P＜005). After 1d, 2d and 7d of surgery, there was no difference in hematoma clearance rate of brain parenchyma between the two groups (P＞005). After 1d, 2d and 7d of surgery, hematoma clearance rate of brain parenchyma in endoscopy group was significantly higher than that in drilling group (P＜005). At the end of surgery, incidence of hydrocephalus and infection in endoscopy group was significantly lower than that in drilling group (P＜005). All patients were followed up for 6 months. The poor prognosis rate in endoscopy group was significantly lower than that in drilling group (2154% vs 3224%) (P＜005). After 6 months of surgery, ADL score in endoscopy group was lower than that in drilling group, while GOS score was higher than that in drilling group (P＜005). Conclusion The application of neuroendoscopy combined with lumbar cistern drainage in treatment of SVH patients can completely remove hematoma and reduce risk of intracranial infection, which can help improve prognosis of patients.