Objective: To analyze the therapeutic effect and prognosis of frameless stereotactic soft channel intracranial hematoma evacuation for severe basal ganglia hemorrhage. Methods: Clinical data of 411 patients with severe basal ganglia hemorrhage admitted to the Neurological Intensive Care Unit of Linyi People’s Hospital from January 2020 to December 2021 were collected. According to the modified Rankin Scale (mRS) score at 180 days after onset, the patients were divided into the good prognosis group and the poor prognosis group. The therapeutic effect of frameless stereotactic soft channel intracranial hematoma evacuation on severe basal ganglia hemorrhage was explored, and the influencing factors of prognosis were analyzed. Results: Multivariate Logistic regression analysis showed that the admission Glasgow Coma Scale (GCS) score was an independent protective factor for the prognosis of patients with severe basal ganglia hemorrhage, while age, preoperative hematoma volume, random blood glucose level, and mechanical ventilation were independent risk factors. Conclusion: Frameless stereotactic soft channel intracranial hematoma evacuation has a good therapeutic effect on severe basal ganglia hemorrhage. However, it is necessary to screen the patients’ basic information before surgery and provide medical care based on their specific conditions to promote their rapid recovery.