Objective To investigate the efficacy of operation for fronto - temporal severe contrecoup injury. Methods 39 patients of severe contrecoup injury got microsurgery through modified pterional approach. The range of bone decompression was judged in light of the pathology on operation. Results According to GOS, of 39 cases, there were better in 16 cases (41%) , moderate main in 8 eases (20.5%) , severe main in 6 cases (15.4%) , vegetarian in 2 cases (5.1%) and death in 7 cases (17.9%) . Conclusion Microsur-gory through modified pterional - approach is effective for fronto - temporal severe contreeoup injury with extensive exposure, big bone window, clear view of operation, sufficient decompression and perfect hemostasia. And this method can reduce mortality rate, decreasehandicapped rate and enhance survival rate.