Objective To summarize the surgical indications, surgical approaches and surgical results of posterior cranial recess epidural hematoma. Methods A retrospective analysis was performed on 45 patients with posterior cranial recess epidural hematoma, all of whom were diagnosed early by cranial CT scan after admission, and the hematoma volume was greater than 10 ml, averaging 30 ml. 33 cases were removed by unilateral suboccipital craniotomy, 3 cases by posterior median craniotomy to remove unilateral epidural hematoma, 8 cases by combined upper and lower curtain craniotomy to remove unilateral riding hematoma, and 2 cases by bilateral occipital craniotomy to remove bilateral posterior cranial recess epidural hematoma. Two cases of bilateral posterior cranial recess epidural hematoma were removed (one of them had bilateral posterior cranial recess epidural hematoma after unilateral suboccipital craniotomy, and bilateral suboccipital craniotomy was performed again to remove the hematoma). The prognosis was determined by GOS, and 40 of the 45 surgically treated cases were good (36 of them had GOS grade 5 at discharge, and the other 4 cases had grade 3-4 at discharge and grade 5 at 6-month follow-up), and 5 cases died. Conclusion Early CT scanning and dynamic CT monitoring greatly improved the early diagnosis of posterior cranial recess epidural hematoma, which led to timely surgical removal of posterior cranial recess epidural hematoma and significantly improved the cure rate and reduced the mortality rate of these patients.