Objective To investigate the clinical efficacy of intraoperative controlling decompression in treating of severe craniocerebral injuries in children. Methods 122 cases of severe craniocerebral injuries in children who needed surgical decompression by craniotomy were randomly divided into control decompression surgical group(60 cases)and conventional surgical group(62 cases).The incidence of postoperative cerebral infarction and the outcome according to GOS scores after 6 months were observed in two groups. Results The incidence of postoperative cerebral infarction was 6.7% in controlling decompression surgical group and 17.7% in conventional surgical group. The differences between two groups were statistical significant(P<0.05); The all poor prognosis patients(severely disabled, vegetative state and death) were 9 cases in controlling decompression surgical group and 23 cases in conventional surgical group. The differences between two groups were statistical significant(P<0.05). Conclusion Intraoperative controlling decompression can significantly reduced the incidence of postoperative cerebral infarction and improved the poor prognosis patients of severe craniocerebral injuries in children.