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Patients with severe and extremely severe brain injury are often treated with fast direct decompression surgery to alleviate brain swelling, however, intraoperative acute brain encephalocele and brain swelling, and postoperative cerebral infarction often occur.The aim of this study was to assess the therapeutic effects of controlled decompression surgery.The study included 128 patients with severe or extremely severe traumatic brain injury who were randomized to either a treatment group that received controlled decompression surgery (n =64) or a control group that received conventional decompressive craniectomy.