Objective To investigate the therapeutic value for decompressive craniectomy (DC) in severe traumatic brain injury (STBI).Methods A total of 132 STBI patients were included in this study, which were divided into DC group and conventional craniotomy group, 66 in each group. After 6 months follow up, clinical efficacy was evaluated as the primary outcome, postoperative complications was evaluated as the secondary outcome.Results After 6 months followed up, 10 patients died (15.2%) in the DC group, 2 patients with prolonged coma (3.0%), 13 patients with severe disabilities (19.7%), 6 patients with moderate disability(9.1%), 35 patients were good (53.0%), respectively. While in the conventional craniotomy group, it was 14 patients (21.2%), 4 patients (6.1%), 20 patients (30.3%), 18 patients (27.3%), and 10 patients (15.2%) respectively. The therapeutic value were more effective in the DC group than that in the conventional group (χ² =37.998, P=0.000). Within 6 months follow up, complications with 7 case(10.6%) of acute brain swelling in the DC group, 5 cases (7.6%) of delayed hematoma, 6 cases (9.1%) of trauma epilepsy, 3 cases(4.5%) of intracranial infection, and 3 cases (4.5%) of leakage cerebrospinal fluid, respectively. The complications in the conventional group were 30.3%, 7.6%, 10.6 %, 3.0%, 3.0%. The DC group has a few complications than that in the conventional group (χ²=4.400, P=0.036). After multivariate adjustment, the effect of decompressive craniectomy has a better opportunity than conventional craniotomy, the OR was 2.173 (P=0.011).Conclusions In the treatment of severe traumatic brain injury, decompressive craniectomy is superior to conventional craniotomy, better prognosis, with less complication.