It is possible not to replace the skull after craniotomy, but it must be treated on a case-by-case basis. If the missing skull area is small, it needs to be properly protected later. If it is true that the skull is not replaced due to some special factors, this is also possible. However, if the skull loss exceeds a certain area, it is recommended that it is safest to replenish the skull. Without the protection of the skull, it is easy to cause intracranial hemorrhage and even rupture of blood vessels again. Therefore, it is best to carry out repair treatment in such cases, and this can also maintain a relatively balanced state of intracranial pressure. In clinical practice, we have encountered some patients who do not repair the skull, but it is not impossible, but it may cause a series of effects on the patient’s life later. Therefore, the decision must be based on the specific condition of the patient, the economic factors of the family, and the patient’s own wishes.