重型颅脑损伤（sTBI）是儿童死亡和致残的主要原因，常会导致患儿颅内压持续性升高，造成神经功能损伤甚至死亡。去骨瓣减压术（DC）通过去除部分颅骨，使脑实质不受限于骨腔，从而增加脑容积以降低颅内压，改善脑灌注压，并降低大脑中线移位、脑干压缩和脑疝的发生风险。然而，儿童DC后常出现新发血肿、硬膜下积液、脑积水、感染、皮肤嵌顿、反常性脑疝及环钻综合征等并发症，部分患儿需行二次或多次手术。因此，DC在sTBI患儿中的应用始终存有争议，且现有高等级循证研究支持有限。本文主要围绕儿童行DC的应用指征及研究进展作一综述，以期为儿童sTBI的手术决策提供理论参考。

Severe traumatic brain injury (sTBI) in children is a leading cause of mortality and disability, often resulting in persistently elevated intracranial pressure, which can cause neurological damage or even death. Decompressive craniectomy (DC) reduces intracranial pressure by removing part of the skull, allowing the brain to expand beyond the confines of the cranial cavity. This procedure increases intracranial volume, improves cerebral perfusion pressure, and reduces the risk of midline shift, brainstem compression, and herniation. However, after DC in children, complications such as new-onset hematomas, subdural effusions, hydrocephalus, infections, scalp invagination, paradoxical herniation, and trephine syndrome often occur. Some children require secondary or multiple surgeries. Therefore, the application of DC in children with sTBI has always been controversial, and existing high-level evidence-based research support is limited. This review focuses on the indications for DC in children and its recent research advances, aiming to provide theoretical reference for surgical decision-making in pediatric sTBI.