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Background: Can decompressive craniectomy improve the outcome of patients with severe brain injury and cerebral herniation following blunt trauma? Objective: To assess the efficiency of decompressive craniectomy in the management of severe brain injury with computed tomographic (CT) evidence of cerebral herniation following blunt trauma. Methods: The studied period was over 36 months (January 2007-December 2009) at Douala General Hospital, Douala, Cameroon. Patients included were those who underwent decompressive craniectomy as a result of nonresponsiveness to conservative management of blunt trauma to the brain with CT scan evidence of cerebral herniation. Patients’ outcome was reassessed two to ten months following decompressive craniectomy using Glasgow outcome scale (GOS) score. Results: Thirteen patients were studied. Ten patients (76.93%) had good outcomes (GOS 1-2). One patient (7.69%) remained in a vegetative state (GOS 4) and two patients (15.38%) died (GOS 5). Noted main complications were hydrocephalus, brain herniation through the orifice of craniectomy, brain abscess and status epilepticus. Conclusion: Decompressive craniectomy can improve the outcome of patients who have suffered severe brain injury with cerebral herniation from blunt head trauma.