Objective To investigate the risk factors for postoperative cerebral hernia after severe craniocerebral injury.Methods A retrospective analysis was performed for the clinical data of 120 patients with severe craniocerebral injury who were admitted in Suzhou Hospital of Anhui Medical University from June 2018 to June 2021. A statistical analysis was performed for the incidence and mortality rates of brain herniation， and the risk factors for brain herniation were summarized.Results Of all patients， 33 experienced brain herniation after surgery， and the incidence rate of brain herniation was 27.50%. There was a significant difference in mortality rate between the complicated group and the non-complicated group （27.27% vs 11.49%， χ² = 4.470， P = 0.035）. The multivariate logistic regression analysis showed that age >60 years， smoking history， preoperative GCS score ≤6 points， atrial fibrillation， hyponatremia， preoperative basal cistern compression， half dose of mannitol after surgery， lumbar puncture， and postoperative intracranial hematoma were independent risk factors for brain herniation （odds ratio = 7.382， 6.666， 6.360， 5.912， 5.087， 6.032， 5.228， 5.119， and 5.053， P <0.05）.Conclusions Patients with severe craniocerebral injury tend to have a high risk of brain herniation and a large number of risk factors， and it is necessary to strengthen early warning and give timely intervention. ［Journal of International Neurology and Neurosurgery, 2023, 50(4): 25-28］