Abstract: Objective To study the effective surgical methods for patients with severe craniocerebral injury complicated by cerebral hernia. Methods Standard craniotomy with large bone flap was performed for severe craniocerebral injury complicated by cerebral hernia in 86 patients followed by decompression when necessary after removal of the lesions.The temporal lobe was incised about 1-2cm to expand the transtentorial hernia for the reposition of cerebral hernia under direct vision. Results Favorable prognosis was achieved in 63 patients,with 4 patients in persistent vegetative status and 19 patients died.The mortality rate was 22.1%. Conclusion Standard craniotomy with large bone flap plus transtentorial hernia incision can decrease the mortality and disability rate of patients with traumatic cerebral hernia.