Craniocerebral injuries are a group of diseases with high rates of death and disability. Whether in wartime or peacetime, craniocerebral injuries account for 17%-22% of injuries to all parts of the body. The mortality rate of severe craniocerebral injury is the highest among all parts of the body, as high as 30%-50%. In peacetime, craniocerebral injuries are most common in traffic accidents, and a few are seen in falls, industrial and mining accidents. According to the report of the International Health Organization, there are about 30 million people in the world who suffer from craniocerebral injuries due to traffic accidents every year, among which 1.2 million people die and the direct economic loss reaches 518 billion US dollars. In China, 1 million to 1.5 million people suffer brain injury due to traffic accidents every year, of which 80,000 to 100,000 people die, and the direct economic loss reaches more than 3 billion RMB. There are two peak periods of craniocerebral injury deaths, the first peak period is the pre-hospital emergency stage, accounting for 60% to 80% of all deaths; the second peak period is 2 to 3 weeks after the injury, accounting for 20% to 40% of all deaths. Craniocerebral injury treatment is a neurosurgical problem, standardized treatment is the key to improve the level of treatment. First, the establishment of craniocerebral injury “treatment chain”, craniocerebral injury “treatment chain” refers to the organizational system and technical process of craniocerebral injury treatment. The organizational system of “treatment chain” includes four key links: on-site first aid, transfer, emergency room treatment and in-hospital treatment. In the on-site treatment chain, the key is to establish a national first aid network system covering both urban and rural areas, in order to effectively improve the rescue response time limit and the level of on-site first aid. It is reported that developed countries such as the U.S., Britain and Japan have established first-aid networks covering both urban and rural areas nationwide, and when 120 or 999 receives a first-aid alarm, the first-aid personnel can arrive at the scene of the accident within 5 to 8 minutes to implement the first-aid service, whereas in China, the first-aid centers or first-aid stations have been established at the regional level or attached to a certain hospital. In terms of the time limit for first aid response, for example, in large cities such as Beijing, Shanghai and Chongqing, the average is 11-15 minutes, while most small and medium-sized cities are more than 20-30 minutes. Many towns and villages in the mainland are not even covered by 120 or 999 emergency networks, which is a “bottleneck” problem that seriously restricts trauma emergency care in China. Therefore, it is extremely important to establish a craniocerebral trauma emergency network covering both urban and rural areas of the country to improve the timeframe of emergency rescue. In terms of first-aid transfer, developed countries in the West have already realized a three-dimensional ambulance transfer system by land (ambulance), air (emergency helicopter), and sea (lifeboat/boat), while China’s first-aid transfer is still mainly by ambulance, and the radius of first-aid service is large. As a result, there are many difficulties in the rescue and transfer of the injured in major traffic accidents and earthquake disasters, which make the injured unable to be transferred safely in time or the transfer time is too long, delaying the treatment of the injured. In terms of on-site first aid, the level of treatment of craniocerebral injuries is low because a considerable number of emergency department doctors are rotating doctors sent by various disciplines, with limited specialized knowledge and skills in craniocerebral surgery, coupled with insufficient specialized first aid equipment. Emergency room treatment and in-hospital treatment are mostly handled by specialized doctors, reflecting the level of specialized treatment techniques, including injury determination, resuscitation, surgical treatment, neurological function monitoring and life function support. Our country has a vast area, large differences in economic development, and the development of specialized talents and technology is extremely unbalanced, so the level of treatment of craniocerebral injuries in different regions has great differences. Second, craniocerebral injury surgery and the principle of “minimally invasive” The principle of minimally invasive craniocerebral trauma surgery refers to the correct judgment of the injury, strictly grasp the indications for surgery, and minimize unnecessary surgical operations and brain tissue damage. Surgical treatment of craniocerebral injury is the basic technical means of neurosurgery. Over the past 20 years, China’s craniocerebral injury treatment technology has made great progress, but the development gap is large. In developed areas, county and township hospitals have set up neurosurgery specialties, and the level of business and technology has improved significantly. However, in some economically underdeveloped areas, many city and county hospitals have only set up neurosurgical specialty groups, lack of full-time neurosurgeons, and lack of specialized knowledge and skills, which makes it difficult to implement specialized and effective treatment. In the surgical treatment of craniocerebral injury, there are several problems that need to be paid attention to: one is to correctly grasp the indications for surgery, to prevent delay in the timing of the operation and avoid “excessive” surgery, such as the casualty’s intracerebral hematoma more than 30 mL combined with cerebral contusion and displacement of the midline, should be operated to remove the hematoma as soon as possible. If there is only a thin epidural/subdural hematoma with no midline shift and the patient is conscious, close observation should be performed first, and if the hematoma is not enlarged and there is no impaired consciousness, surgery is not required. Delayed surgery or excessive surgery may cause unnecessary injuries or even endanger the life of the patient; Secondly, minimally invasive techniques of craniocerebral injury surgery, whether it is intracranial hematoma removal, or cerebral contusion combined with severe cerebral edema for decompression of debridement flap, the operation should be meticulous, patient, and handled appropriately. Removal of intracerebral hematoma application of surgical microscope, in good lighting and coaxial magnification conditions, to minimize unnecessary brain tissue and cerebral vascular bed damage; Third, the implementation of decompression surgery to remove the large bone flap to strictly grasp the indications. Studies have shown that decompression surgery can improve the prognosis of patients with traumatic malignant high cranial pressure. For patients with cerebral hernia, severe cerebral edema with high cranial pressure, or brain tissue swelling in craniotomy, decompression of the bone flap should be performed, and the skull bones to be bitten off during decompression should include the frontal, temporal, and parietal 12 cmx15 cm, and temporal bones should be bitten off to the bottom of the middle cranial recess, and at the same time the dura should be repaired, to prevent the brain tissues from adherence and ischemic necrosis by the edge of the bone extrusion after the expansion, which will aggravate the damage to the brain tissues. If there is no brain bulge and the brain pressure is not high, there is no need to perform decompression surgery by removing the bone flap, so as not to increase the surgical trauma and leave behind cranial defects. Strengthening the training of specialists and improving the specialty knowledge and skills of neurosurgeons at the grassroots level are important measures to ensure minimally invasive surgery for craniocerebral injury. Third, craniocerebral injury monitoring about 80% of craniocerebral injury is light injury and medium-sized injury. The vast majority of light injuries do not need special treatment, and only require outpatient observation or symptomatic treatment. However, 0.2% to 0.7% of patients with light injuries without skull fracture have aggravated conditions; 3.2% to 10% of patients with skull fracture have aggravated or even worsened conditions. In patients with medium-sized craniocerebral injuries combined with cerebral contusions, delayed hematomas may develop within a few days. Therefore, these two types of patients should be hospitalized for close observation. Heavy craniocerebral injury accounts for about 20% of all craniocerebral injuries, with a high rate of death and disability, and is the focus of treatment. Because of this, patients with severe craniocerebral injury need to be closely monitored in neurosurgical ICU, which is the key to improve the success rate of craniocerebral injury treatment. The monitoring of craniocerebral injury belongs to the important content of in-hospital treatment, including the specialized treatment process of neurosurgery ICU and traumatic brain injury ward. With the rapid development of medical science and technology, the monitoring of patients with craniocerebral injury has not only been limited to blood pressure, pulse, respiration, electrocardiography, blood oxygen, blood biochemistry and other routine indicators, but also developed to the direct monitoring of the cranium and brain, including intracranial pressure (ICP), cerebral perfusion pressure (CPP), cerebral blood flow (CBF), partial pressure of oxygen in the brain tissue (Pbt02), and brain tissue temperature (BT). The above direct brain tissue monitoring techniques have been widely used in Europe, the United States, Japan and other developed countries, which have significantly improved the protection of secondary brain damage in patients with craniocerebral injury and effectively improved the prognosis of patients. In China, these monitoring programs have only been carried out in some large hospitals in Beijing, Shanghai, Tianjin, Guangzhou, Xi’an, Changsha, Chongqing, etc., which to a certain extent affects the level of treatment for patients with severe craniocerebral injury. Therefore, it is necessary to raise the awareness of the importance of direct craniocerebral monitoring, increase the research on the prevention and control measures of secondary brain damage in craniocerebral injury, and further improve the overall level of treatment of craniocerebral injury. Fourth, craniocerebral injury nerve regeneration and functional repair Heavy craniocerebral injury patients have a high rate of severe disability. According to the statistics of large number of cases, 12% to 17% of patients have serious neurological damage such as hemiplegia, aphasia, mental retardation or long-term coma. The treatment of nerve regeneration and functional repair is extremely difficult. The reasons for the difficulty of nerve regeneration and functional repair in brain injury are complex and include the following: (1) neuronal regeneration is difficult in higher vertebrates after injury to the central nervous system (brain and spinal cord); (2) destruction of the microenvironment of the extracellular matrix, which is not suitable for neuronal regeneration; (3) lack of neurotrophic factors; (4) myelin synthesis by the myelin sheaths of the central nerves, including myelin-associated proteins such as MAG, Nogo and OMpg, inhibits the growth of nerve axons; (5) the lack of nerve trophic factors; (6) the lack of nerve regeneration by the myelin sheaths of the central nerves, which is not suitable for nerve regeneration. (4) inhibition of nerve axon growth; (5) formation of glial scar or soft necrotic foci in the injured area, which impedes nerve regeneration. Many scholars have conducted in-depth studies on the above molecular pathologic mechanisms, and some important progress has been made by using neural stem cell transplantation to replenish nerve cells, composite neurobiomaterials to carry neurotrophic factors, and DNA vaccines to eliminate endogenous nerve regeneration inhibitory effects. Significant progress has been made in recent years in the basic research of neural stem cell transplantation for repairing and reconstructing nerve function. Neural stem cells come from a wide range of sources, including embryonic stem cells, stem cells of clonal origin, induced pluripotent stem cells (IPS), bone marrow mesenchymal stromal cells, adipocytes, umbilical cords and umbilical cord blood, amniotic membrane cells and so on, among these cells, their own adult stem cells (bone marrow mesenchymal stromal cells, adipocytes), because of the absence of ethical controversy and immune rejection, as a new clinical technology of the third category, has been carried out in some hospitals. As a new clinical technology of class III, it has been carried out in some hospitals as a clinical experimental treatment, and some patients have achieved more obvious therapeutic effects. Its therapeutic mechanism may be to replenish nerve cells and neurotrophic factors, change the microenvironment of nerve regeneration, and improve the symptoms of neurological impairment to different degrees. In summary, craniocerebral injury has the characteristics of sudden onset and high mortality and disability rate, in order to improve the success rate of craniocerebral injury and realize standardized treatment, it is necessary to further strengthen the research on the mechanism of secondary damage of craniocerebral injury, strengthen the cultivation of specialists, pay attention to the development of first aid and guardianship equipments, and the promotion of trauma first aid technology, as well as carry out in-depth research on the basics and application of nerve regeneration and functional repair.