Traumatic brain injury is the leading cause of death and severe disability in young people, and its most important complication is intracranial hematoma. Without effective surgical management, intracranial hematomas are likely to turn a benign recoverable clinical course into death and persistent vegetative survival, and delays in the diagnosis and treatment of intracranial hematomas can have similar consequences. The guideline aims to provide thoughtful literature-based recommendations for the surgical management of patients with posttraumatic intracranial occupying lesions, primarily selecting literature on acute occupying lesions occurring within 10 days of trauma, but not on late lesions such as chronic subdural hematomas, subdural hydrocele, and posttraumatic hydrocephalus. Also, the guideline focuses on closed craniocerebral injuries, as many guidelines for the treatment of open traumatic brain injuries already exist. The guidelines classify post-traumatic occupying lesions according to the traditional classification of the literature, i.e., into acute epidural hematoma, acute subdural hematoma, intracerebral parenchymal injury (cerebral contusion and intracerebral hematoma), acute posterior cranial fossa hematoma, and depressed skull fracture. Of course, most patients with severe traumatic brain injury and some patients with moderate traumatic brain injury may have more than one posttraumatic occupying lesion, for example, most patients with acute subdural hematoma are also found to have cerebral contusions on CT scan. Some patients may have multiple occupying lesions in the brain parenchyma, such as bilateral frontal lobe contusions, bilateral temporal lobe contusions, or simultaneous temporal and frontal lobe injuries. Treatment options are easier for larger lesions (>50 cm3), with surgery generally preferred, and for smaller lesions.