Objective To compare and analyze the therapeutic between improvement craniotomy and standard trauma craniotomy in severe brain injury. Methods To select 54 patients with severe brain injury , randomly divide into two groups ( the improvement craniotomy group and the standard trauma craniotomy group). Results the improvement craniotomy group’s GCS and GOS recover more quickly and good than the standard trauma craniotomy group. Conclusion the improvement craniotomy group can more thoroughly decompress and more utility conservate the brain function than the standard trauma craniotomy group, can obviously improve prognosis of the patients with severe brain injury.