[Abstract] Purpose: To summarize the application of sequential dura cut in severe craniocerebral injury surgery. Methods: 37 cases of severe craniocerebral injuries were treated with “standard traumatic large bone flap”, and the dura was cut by sequential method during the surgery, and these 37 patients were analyzed retrospectively. Results: After discharge from the hospital, the GOS prognosis was 5 cases with good outcome, 6 cases with moderate disability, 6 cases with severe disability, 4 cases with vegetative state, and 16 cases with death (mortality rate of 43%). CONCLUSION: Adopting the sequential method to cut the dura mater in heavy craniocerebral injury surgery can significantly reduce the incidence of intraoperative acute cerebral bulging and greatly improve the patient’s prognosis. In heavy craniocerebral injuries, especially in patients with large frontal and temporal lobe contusions, it is easy to lead to brain herniation and even respiratory and cardiac arrest, resulting in the patient’s death. In the surgical process of such patients, such as hastily cut open all the dura mater, the patient is easy to cause acute brain swelling, resulting in the operation can not be cleaned up, or even hastily ended, the patient mortality rate is very high, and the author in the operation to take the sequence method of cutting open the dura mater, in the surgical process to achieve good results, is reported as follows: Clinical data 1.1 General data of this group of patients a total of 37 people, of which 26 are male and 11 are female. , the average age of 43 years old, all of them were closed craniocerebral injury, the time from injury to admission was from 1 to 7 hours, with an average of 3 hours. 1.2 Clinical manifestations: 30 cases of deep coma at the time of admission, 7 cases of moderate coma, GCS score: 8 cases of 5 points, 7 cases of 4 points, 18 cases of 3 points, 13 cases of bilateral pupil dilatation, 14 cases of one-side pupil dilatation, and 10 cases of craniocerebral injury combined with other organ injuries. 1.3 Auxiliary examination: head CT showed 29 cases of unilateral craniocerebral injury (epidural, subdural hematoma, cerebral contusion, intracerebral hematoma, subarachnoid hemorrhage) and 8 cases of bilateral craniocerebral injury. Unilateral hematoma often had obvious midline structural displacement, and there were 28 cases with displacement more than 1cm, while most of the bilateral hematomas did not have obvious midline displacement, and most of them manifested diffuse brain swelling (based on the disappearance of tricerebral ventricle, ring pool, basal pool). 1.4 Surgical treatment: 37 patients were used “standard trauma large bone flap” surgery, sequential incision of the scalp, remove the bone flap, bite off the scales of the temporal bone a few and the bottom of the middle cranial fossa flat, and then bite off the lateral pterygoid ridge, try to decompression sufficient, then the hand touch can sense the intracranial pressure, such as high cranial pressure, do not immediately cut the dura along the pterygoid ridge arc, but in the temporal part parallel to the bone, and then cut open the dura. Rather, the temporal dura mater is cut parallel to the bone window in the temporal region, with the purpose of removing temporal hematoma, contused brain tissue and internal decompression of brain tissue, such as the temporal pole, and then open the frontal dura mater with the same technique, removing the frontal hematoma, contused brain tissue and frontal pole, and finally cut open the lateral fissure meninges, so that decompression can be achieved one by one to achieve a more “relaxed”, and the decompression suture can be performed in a short period of time. In this way, decompression can be achieved step by step, and it can be done in a more “relaxed” way, and the decompression suture can be performed in a short time, so as to avoid the long exposure of brain tissue and brain tissue bulging. There were 6 cases of bilateral pupil dilation and retraction and 12 cases of unilateral pupil dilation and retraction. The prognosis was assessed according to the post-discharge GOS: 5 cases with good prognosis, 6 cases with moderate disability, 6 cases with severe disability, 4 cases with vegetative state survival, and 16 cases with death (mortality rate of 43%). Discussion: Heavy craniocerebral injury is characterized by intracranial hematoma, extensive cerebral contusion, brain swelling, often displaced midline structures, compressed ventricles, and unclear ring pools on CT films, and this kind of patients are prone to brain herniation, followed by respiratory and cardiac arrest, and patient death. In this kind of surgery, I mostly use “standard traumatic large bone flap”, and cut open the dura with sequential method during the surgery, so as to achieve good surgical results, and now the experience is shown as follows: 3.1, the need for surgical treatment should be performed as early as possible, and it is often necessary to compete for time in this kind of patients, and the earlier the surgical treatment is performed, the more the patients’ chances of survival after the surgery will be. The earlier the surgery is performed, the more chance the patient will survive after the surgery. There is an important surgical principle that the surgery should be performed before the brain hernia, so that the difficulties faced during and after the surgery will be much less. 3.2 Gradual decompression, sequential method of cutting open the dura mater, in the process of surgery, after removing the bone flap, the intracranial pressure can be sensed through the hand touch, such as cranial pressure is very high, do not cut open the dura mater hastily, which often causes malignant brain swelling and make the operation can not be carried out normally, according to the preoperative cranial CT, in the place where there is a lot of blood accumulation or the most obvious cerebral swelling will be the dura mater to cut open a small mouth, let out the subdural accumulation of blood, every cut a dura, first deal with hematoma, hematoma, swelling, and then cut a small hole, and then cut a small hole. For each incision of the dura mater, hematoma, contusion and the required removal of internal decompression of brain tissue should be dealt with first. The order of incision of the dura mater should be temporal, then frontal, then lateral fissure, and then completely open after decompression is more adequate. The temporal part should be opened first mainly to alleviate the pressure on the brain stem, and the range of internal decompression can be considered according to the situation of the brain pressure, and the decompression is sufficiently acceptable, and then the decompression suture should be performed quickly to avoid the exposure of brain tissues for a long period of time. 3.3 Surgery adopts “standard traumatic large bone flap” to open the cranial decompression, but in the operation, there is much bleeding, trauma, and large cranial defects remain after the operation, which may lead to hydrocephalus, large cerebral softening, penetrating deformity, epilepsy and other high incidence, therefore, in the removal of the bone flap, it can be considered that the bone flap does not need to be too backward or upward, and the hematoma that is prolonged to the top of the frontal head and the top of the occipital head can be washed out by suction while washing, and it can be washed out by suction. The hematoma can be easily removed by flushing while suctioning, and the bleeding from the reflux vein can be easily stopped by compression or electrocoagulation. 3.4 In addition, the methods that help a lot in surgery and postoperative period also have sufficiently biting off the squamous part of the temporal bone, so that the bone window is down to the bottom of the middle cranial fossa, so that the brain tissue is not easy to be embedded, and the decompression is relatively sufficient, and biting off the crest of the pteronotibial bone, so that the degree of the venous compression at the lateral fissure is less, and the decompression suture reduces the compression of the brain tissue, and it can also prevent the leakage of the cerebrospinal fluid. 3.5 A set of correct and standardized postoperative resuscitation and nursing measures such as timely tracheotomy and subcooling also play a rather important role in the rescue process of such patients. To summarize, the sequential method of cutting the dura mater in the surgical process of treating patients with severe craniocerebral injuries can effectively improve the acute cerebral bulging of the patient during the operation, which has positive and important significance for the patient’s operation and the patient’s healing after the operation.