Objective: To investigate the effect of stepped decompression strategy combined with decompressive craniectomy (DC) on intraoperative acute encephalocele and short-term prognosis in patients with severe traumatic brain injury (sTBI). Methods: The clinical data of 83 patients with sTBI were retrospectively analyzed and patients were divided into a study group (n=38) and a conventional group (n=45, standard DC) according to whether the stepped decompression strategy was used in DC operation. The operation indexes, complications, and postoperative coma were observed, and Glasgow Outcome Scale (GOS) was compared between the two groups six months after surgery. Results: The operation time and blood loss in the study group were less than those in the conventional group (t=3.097, 2.614; P<0.05). The intraoperative delayed hematoma and acute encephalocele were significantly lower than those in the conventional group (χ2=4.585, 4.024; P<0.05). The rate of postoperative cerebral infarction in the study group was lower than that in the conventional group, but the difference was not significant (P>0.05). The Glasgow Coma Scale (GCS) in the study group was higher than that in the conventional group 7 and 14 days after the operation (t=2.392, 2.430; P<0.05). The GOS score 6 months after the operation was higher than that in the conventional group (t=2.725, P<0.05), and the good rate of short-term prognosis was higher than that in the conventional group (χ2=4.270, P<0.05). Conclusion: Stepped decompression strategy combined with DC can reduce the occurrence of delayed hematoma and acute encephalocele in sTBI patients, promote postoperative recovery and improve the short-term prognosis.