Objective To discuss the experiences in successful treatment of hyperacute traumatic intracranial hematoma with percutaneous puncture and craniotomy.Methods Pereutaneous puncture and craniotomy was performed in 12 patients with hyperacute traumatic intracranial hematomas including seven with subdural hematoma,three with epidural hematoma and two with episubdural hematoma.Before operation,there found enlargement of bilateral pupil in six patients,enlargement of unilateral pupil in six and changed breathing rhythmicity in eight.Glasgow Coma Scale(GCS)was 3 points in four patients,4 points in six and 7 points in two.Results After pereutaneous puncture,enlarged pupil was retracted at different degrees in nine patients and spontaneous breathing conditions improved in seven.After crani otomy,two patients died within 24 hours,four died after 24 hours but six patients survived.The follow-up for 0.5-2 years showed four patients with sound Glasgow Outcome Score,two at vegetative state and six deaths.Conclusion Percutaneous puncture combined with craniotomy is an effective way for hyperacute intracranial hematoma.