Despite the increasing acceptance of decompressive craniotomy in patients with traumatic brain injury, the value of early decompressive craniotomy (DC) in patients with acute subdural haematoma is still under debate. In this study, we reviewed 20 patients with traumatic acute subdural haematoma, 10 of whom were treated with haematomaevacuation via burr holes craniotomy and 10 of whom weretreated with DC. The mortality rate was higher in the craniotomy group (80% vs. 50%) than in the DC .Although DC is a more lengthy procedure, with higher incidence of convulsions, subgaleal effusion than burr hole craniotomy, but it has less incidence of residual SDH, better control on the source of bleeding, consecuantly less incidence of rebleeding and need for reoperation,and has better results in lowering of the ICP radiologically, associated with lower mortality and better functional recovery.. Age and signs of herniation were significantly associated with an unfavourableoutcome, regardless of the type of surgery. . Apart from initialGCS and the pupillary status, time elapsedbetween trauma and treatment is the most important and can be intervened. Even equally significant is a treatment in a specialized center