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Purpose: To investigate the changes of cerebral hemodynamics pre-and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling.Methods: Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively.Patients in nonsurgical group were treated by medicine therapy.Patients in surgical group were treated by extal ventricular drainage plus medicine therapy.The first CT perfusion scan was completed within 4 -5 h after trauma and scanned again after 7 days.The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment.Result: Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporopadetal grey matter, basal ganglia, cerebellum, and brain stem at pre-and post-therapy were increased significantly (p ＜ 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group.Conclusion: Extal ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.