Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy.Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group.The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow-up after operation were compared between the two groups.Results: Fifteen patients (15.6%) died in the standard large trauma craniotomy group and 30 (27.7%) in the routine craniotomy group.The postoperative mean ICP was 3.75 kPa±1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa±1.57 kPa in the routine craniotomy group.The pupil rebound was found in 47 patients (61.0%) in the standard large trauma craniotomy group and in 41 patients (46.1%) in the routine craniotomy group (P<0.01).The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long-term therapeutic effect was found between the two groups.Conclusions: Standard large trauma craniotomy can attenuate brain hia and the mortality of the patients with acute subdural hematoma .The incidence of complication can also be decreased.But the long term life quality of the patients can not be improved.