Neurosurgery tracheotomy timing indications 1, brainstem injury, thalamic injury, diffuse axonal injury and other deep coma, brain contusion, cerebral hemorrhage resulting in brain herniation after surgery, consider patients who can not wake up within a week, tracheotomy as soon as possible; 2, the original lung disease, or a long history of smoking, or serious misaspiration, etc., consider a short period of time can not wake up, and it is easy to appear pulmonary infection, respiratory tract is not smooth Patients should be tracheotomized as early as possible; 3, skull base fracture, more bleeding from the mouth and nose, patients with impaired consciousness and easily misaspirated, tracheotomized as soon as possible; 4, various reasons for the patient’s gag reflex to weaken significantly or disappear, such as posterior cranial fossa tumor postoperative injury to the posterior group of cranial nerves, brain stem hemorrhage, etc., should be tracheotomized as early as possible. For patients with postoperative tumor involving posterior group of cranial nerves with tracheal intubation, patients whose pharyngeal reflex is not obvious after consciousness, must pay attention, can properly move the tracheal intubation, stimulate the patient to see whether they have pharyngeal reflex, if there is no obvious pharyngeal reflex, must be careful, there may be asphyxia caused by misaspiration after extubation, for such patients, tracheotomy can be considered according to the specific situation; 5, for epidural 5. For patients with brain herniation caused by epidural hematoma, such as those who have undergone surgery for a short period of time after the appearance of brain herniation, each patient will decide whether to be tracheotomized according to the recovery of consciousness after surgery, and sometimes the patient will be awake 1-2 days after surgery, so tracheotomy is not necessary.