To explore the influencing factors for pathological diagnosis rate and postoperative hemorrhage in stereotactic biopsy of intracranial lesions. Methods: A total of 110 patients who underwent stereotactic brain lesion biopsy were enrolled. According to whether the pathological results after operation were clearly diagnosed, they were divided into definite pathological diagnosis group and indefinite pathological diagnosis group. Ninety-eight patients were rechecked by CT after operation and were divided into postoperative hemorrhage group and non-hemorrhage group according to the presence or absence of hemorrhagic signs. The clinical data and surgical related variables of the patients in different groups were compared respectively, and the influencing factors for pathological diagnosis rate and postoperative hemorrhage of stereotactic brain lesion biopsy were analyzed. Results: Pathological diagnosis was made in 92 cases (83.6%). The preoperative imaging localization method was the influencing factor for pathological diagnosis of stereotactic brain lesion biopsy(P<0.05), and the patients with MRI localization had a higher rate of pathological diagnosis. Prothrombin time,international normalized ratio and high-grade glioma were the influencing factors for postoperative hemorrhage(P<0.05), among which high-grade glioma was an independent risk factor for postoperative hemorrhage after stereotactic brain lesion biopsy (OR=5.502, P=0.005). High-grade glioma has predictive value for hemorrhage after stereotactic brain biopsy, with sensitivity of 0.35, specificity of 0.914, positive predictive value of 0.737, negative predictive value of 0.671, Youden index of 0.264, and area under curve of 0.632 (P=0.027). Conclusion: MRI localization before stereotactic brain lesion biopsy can significantly increase the pathological diagnosis rate. High-grade glioma is an independent risk factor for postoperative hemorrhage.