Traumatic brain injury is the leading cause of death and severe disability in young people, and its most important complication is intracranial hematoma. The incidence of intracranial hematoma ranges from 25% to 45% in heavy traumatic brain injury, 3% to 13% in medium traumatic brain injury, and 1/500 in light traumatic brain injury. without effective surgical treatment, intracranial hematoma is likely to evolve a recoverable benign clinical course into death and persistent vegetative survival, and delays in the diagnosis and treatment of intracranial hematoma can produce similar results. Post-traumatic occupying lesions are classified according to the traditional literature classification, 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 medium-sized traumatic brain injury can have more than one post-traumatic occupying lesion at the same time; for example, most patients with acute subdural hematoma are found to also have cerebral contusions on CT scan. Surgical treatment of acute epidural hematoma [Indications for surgery] Regardless of the patient’s GCS score, as long as the acute epidural hematoma volume exceeds 30 cm, surgical removal of the hematoma is indicated. Patients with hematoma volume less than 30 cm, hematoma thickness less than 15 mm and midline shift less than 5 mm, if the GCS score is higher than 8 and there is no focal functional deficit, they can be treated non-operatively under dynamic neurological observation and close observation by the neurosurgery center. Timing of surgery] Patients with acute epidural hematoma with coma (GCS score less than 9) and unequal pupil size are strongly recommended to undergo hematoma removal as early as possible. There is no sufficient evidence to support that one procedure is better than the other. However, craniotomy can remove the hematoma more completely. Surgical treatment of acute subdural hematoma [Indications for surgery] Regardless of the GCS score of a patient with an acute subdural hematoma, surgical removal of the hematoma is indicated as long as the CT scan shows a thickness of more than 10 mm or a midline shift of more than 5 mm. All patients with acute subdural hematoma in a comatose state (GCS score less than 9) should be monitored for intracranial pressure. Patients with acute subdural hematoma with a hematoma thickness thinner than 10 mm, midline shift less than 5 mm and in a comatose state (GCS score less than 9) should have surgical removal of the hematoma if the GCS score on admission is 2 or more points lower than at the time of injury and/or the pupils are unequal or fixed and dilated and/or the intracranial pressure exceeds 20 mmHg. Timing of surgery】 Patients with acute subdural hematoma who have indications for surgery should undergo surgical hematoma removal as early as possible. 【Procedure】 Comatose patients with acute subdural hematoma with indications for surgery (GCS score <9) should undergo craniotomy with debridement and decompression plus duralplasty or without debridement and decompression. Surgical treatment of traumatic intracerebral hematoma [Indications for surgery] Patients with intracerebral parenchymal hematoma, progressive neurological decompensation, refractory intracranial hypertension, and CT showing occupying effects should undergo surgery. patients with a GCS score of 6 to 8 and CT scans showing hematoma volume of more than 20 cm, midline shift of ≥5 mm, and/or cerebral pool compression in their frontal or temporal lobe cerebral contusions, and any site of those with hematoma volumes greater than 50 cm should undergo surgical treatment. Patients with intracerebral parenchymal hematoma without signs of neurological damage and with controlled intracranial pressure and no significant occupying effect on CT scan may be given nonoperative treatment under close monitoring as well as dynamic imaging observation. Patients with limited hematoma and those who meet the above indications are recommended to undergo craniotomy for hematoma removal. Bifrontal decompression performed within 48 h after injury is a treatment option for patients with diffuse, refractory cerebral edema and its resulting intracranial hypertension. Decompressive surgery (including subtemporal muscle decompression, temporal lobectomy, and hemispheric craniotomy decompression) is a treatment option for patients with refractory intracranial hypertension and diffuse parenchymal brain injury with clinical and radiological evidence of impending herniation of the cerebellar curtain notch. Surgical treatment of posterior cranial fossa hematoma [Indications for surgery] Patients whose CT scan shows an occupying effect or who present with neurological deficits or decompensation should receive surgical treatment. occupying effect as shown on CT scan is defined as deformation, displacement or loss of the fourth ventricle, compression or loss of the basal pool, or the presence of obstructive hydrocephalus. patients whose CT scan does not show an occupying effect and who do not present with neurological deficits can be treated under close observation and Patients with no occupying effect on CT scan and no neurological deficits can be treated non-operatively under close observation and dynamic imaging. The reason is that the condition of these patients can deteriorate rapidly and eventually lead to a poor prognosis. Suboccipital craniotomy is the main method to remove posterior cranial fossa hematoma. Surgical treatment of depressed skull fractures [Indications for surgery] Patients with open (compound) depressed skull fractures with depression greater than the thickness of the skull should receive surgical treatment to avoid infection. Patients with open (compound) depressed skull fractures without clinical or imaging evidence of dural rupture, significant intracranial hematoma, depression >1 cm, frontal sinus rupture, severe cosmetic disfigurement, wound infection, pneumocephalus, or severe wound contamination may be treated non-operatively. Patients with closed (simple) depressed skull fractures can receive non-operative treatment. Timing of surgery】 Early surgery is advocated to reduce the risk of infection. Surgical method] Fracture fragment prying up and wound debridement are recommended as surgical methods. If wound infection is not present, recovery of the original fracture fragment is a surgical treatment option. Patients with open (compound) skull depression fractures should be given antibiotic therapy.