Objective To compare the efficacy of progressive decompression versus routine decompression in the treatment of severe traumatic craniocerebral injury.Methods A total of 148 patients with severe traumatic craniocerebral injury who were admitted to our hospital and underwent surgical treatment from January 2012 to May 2016 were enrolled and randomly assigned to progressive decompression group (80 patients) and routine decompression group (68 patients). All patients received the same therapeutic treatment after operations. Pre- and post-operative Glasgow Coma Scale (GCS) score, complications, and Glasgow Outcome Scale (GOS) score at 3 months post-operation were compared between the two groups.Results The GCS score showed no significant differences between the two groups before surgery and at 1, 2, 3 days post-surgery, but showed significant differences at 7 and 14 days and 1 month after surgery. As for the GOS score at 3 months after surgery, there were 15 cases of good recovery, 27 cases of moderate disability, 16 cases of severe disability, 8 cases of persistent vegetative state, and 14 cases of death in the progressive decompression group, and 10 cases of good recovery, 13 cases of moderate disability, 15 cases of severe disability, 13 cases of persistent vegetative state, and 17 cases of death in the routine decompression group, with a significant difference between the two groups (P<0.05). The incidence of complications showed a significant difference between the two groups (P<0.05).Conclusions Compared with routine decompression, progressive decompression provides better post-operative recovery and fewer complications for patients with severe traumatic craniocerebral injury.