Difficulties in treating subjects with acute subdural hematomas and low Glasgow Coma Scale (GCS) scores (5 or less) were studied in 30 patients using two different surgical treatments. The outcomes in these patients were good for 13% poor for 23% and fatal for 63%. The ICP was well controlled in 2 patients (12%) in the DH (decompressive hemicraniectomy) group. No patient was well controlled in the HITT (hematoma irrigation with trephination therapy) group. Uncontrollable ICP occurred more frequently in the HITT group than in the DH group. The mortality rate was 56% for the DH group and 71% for the HITT group. The mortality rate of older patients, however, was 100% for the DH group and higher than 67% for the HITT group. This preliminary work demonstrates that decompressive craniectomy is more effective in controlling ICP and in improving the outcomes of patients with acute subdural hematomas and low GCS scores.