At present, there are controversies at home and abroad about the indications, timing and methods of surgical treatment for patients with craniocerebral trauma, especially acute craniocerebral trauma. American neurosurgeons have collected more than 800 articles (secondary or tertiary evidence) published in international medical journals on the basis of surgical aspects of craniocerebral trauma. In view of China’s neurosurgeons in craniocerebral trauma surgery has accumulated rich clinical experience, combined with China’s craniocerebral trauma patient injury characteristics and medical conditions, China’s Neurological Trauma Expert Committee convened more than 60 neurosurgeons, carefully analyzed China’s craniocerebral trauma patient surgery successes and failures, and prepared a craniocerebral trauma patient surgery experts suitable for China’s national conditions. Consensus, in order to guide our country engaged in craniocerebral trauma diagnosis and treatment of physicians of clinical medical practice, improve the level of craniocerebral trauma patients in China. (I) Acute epidural hematoma 1. Indications for surgery: (1) Acute epidural hematoma >30 ml, temporal >20 ml, immediate craniotomy is required to remove the hematoma; (2) Acute epidural hematoma <30 m1, temporal <20 ml, maximal thickness <15 mm, midline shift <5 mm, and gcs score >>8 points. Patients without signs and symptoms of focal brain damage can be treated conservatively. However, they must be hospitalized for close observation of disease changes, and head CT is performed for dynamic observation of hematoma changes. Once the clinical consciousness changes, high cranial pressure symptoms, and even pupil changes or CT hematoma enlargement, should be immediately craniotomy hematoma removal surgery. Surgical method: according to the hematoma site to take the corresponding area of the bone flap craniotomy, remove the hematoma and complete hemostasis, the edge of the bone window to suspend the dura mater, the bone flap in situ restoration and fixation. However, for patients with huge epidural hematoma, obvious midline shift and pupil dilatation, bone flap decompression and dural decompression suture technique can be used to avoid secondary high cranial pressure and brain hernia caused by large cerebral infarction after surgery, and again perform bone flap decompression surgery. (B) Acute subdural hematoma 1, surgical indications: (1) acute subdural hematoma >30ml, temporal >20ml, hematoma thickness >10mm, or midline shift >5mm patients, need to immediately use surgery to remove the hematoma; (2) acute subdural hematoma <30ml, temporal <20ml, the maximum thickness of the hematoma <10mm, midline shift <5mm, gcs score <9 points Patients with acute subdural hematoma can be treated non-operatively first. If there is post-injury progressive impaired consciousness and a decrease in gcs score >2 points, surgical treatment should be used immediately; (3) For hospitals with intracranial pressure monitoring technology, intracranial pressure monitoring should be performed in all patients with a GCS score of <8 points for severe craniocerebral trauma combined with intracranial hemorrhage. 2. Surgical methods: For the most common acute subdural hematoma of the frontotemporal parietal, especially for patients with high cranial pressure in combination with cerebral contusion, standard large bone flap craniotomy is advocated to remove the hematoma, and according to the preoperative GCS score, the presence of cerebral herniation, and the intraoperative intracranial pressure, it is decided to retain or de-bone the flap for decompression, and the dura mater is closed in situ with in situ suturing or reduction suturing. Bilateral frontotemporal-parietal acute subdural hematoma should be performed with bilateral standard traumatic large bone flap surgery, or anterior coronal craniotomy with debridement and decompression of the large bone flap. (C) Acute intracerebral hematoma and cerebral contusion 1. Indications for surgery: (1) For patients with acute parenchymal brain injury (intracerebral hematoma, cerebral contusion), if there is progressive impairment of consciousness and neurological function, medication fails to control high cranial pressure, and there is a significant space-occupying effect on CT, surgical treatment should be performed immediately; (2) Frontal-temporal-parietal contusion with a volume of >20 ml and a midline shift of >5 mm, accompanied by basilar pool compression, surgery should be performed immediately; (3) Frontal-temporal-parietal contusion volume >20 ml, with midline shift >5 mm, accompanied by basilar pool compression, surgery should be performed immediately. Pool compression, should be immediately surgical treatment; (3) acute parenchymal brain injury patients, through dehydration and other drug treatment intracranial pressure ≥ 25mmHg, cerebral perfusion pressure ≤ 65mmHg, should be surgical treatment; (4) acute parenchymal brain injury (intracerebral hematoma, cerebral contusion) patients with no change in consciousness and neurological damage, drugs can effectively control high cranial pressure, CT does not show significant occupying effect, can be in close observation of consciousness and neurological damage, can be in close observation of consciousness and brain injury, can be in close observation of the brain injury, and can be in close observation of the brain injury. If the patient has no change of consciousness and neurological damage, the drugs can effectively control high cranial pressure, and CT does not show obvious space-occupying effect. Surgical methods: (1) for frontotemporal parietal extensive cerebral contusion injury combined with intracerebral hematoma, CT showed obvious space-occupying effect of patients, we should advocate the use of standard traumatic craniotomy to remove intracerebral hematoma and inactivation of cerebral contusion tissues, complete hemostasis, routine decompression of the bone flap, dural decompression sutures; (2) for the absence of intracerebral hematoma, frontotemporal parietal extensive cerebral contusion brain swelling combined with difficulty in controlling high intracranial pressure, signs of cerebellar hernia. (2) For patients without intracerebral hematoma, extensive cerebral swelling in the frontotemporal parietal brain contusion injury combined with difficulty in controlling high cranial pressure, and signs of cerebellar herniation, standard traumatic large bone flap craniotomy should be routinely carried out, with dural decompression sutures, and depressurization of the bone flap; (3) For patients with a simple intracerebral hematoma, no obvious contusion trauma, and a significant space-occupying effect on CT, the hematoma should be removed by craniotomy using a larger flap at the corresponding site in accordance with the site of the hematoma and hemostasis should be carried out thoroughly. (4) For multiple hematomas in the brain caused by posterior occipital landing deceleration injury, bilateral cerebral hemispheric brain parenchymal injury (intracerebral hematoma, cerebral contusion) caused by impact injury, craniotomy should be performed on the lesion on the side of the serious injury first, and bilateral craniotomy with large bone flap decompression surgery should be performed if necessary. (D) Acute posterior cranial fossa hematoma 1, surgical indications: (1) posterior cranial fossa hematoma > 10 ml, CT scan has a placeholder effect (deformation, displacement or occlusion of the fourth ventricle, the basal pool is compressed or disappeared, obstructive hydrocephalus), should be immediately surgical treatment; (2) posterior cranial fossa hematoma regular review of the CT.