〔Abstract〕 Objective To analyze the effect of ICP monitoring combined with standard large trauma craniotomy on elderly patients with craniocerebral injury. Methods 80 elderly patients with craniocerebral injury admitted into the First Affiliated Hospital of Fujian Medical University from January 2019 to December 2020 were selected and divided into the observation group (42 cases) and the control group (38 cases). The control group received standard large trauma craniotomy, and the observation group received ICP monitoring on the basis of standard large trauma craniotomy. The two groups were compared in preoperative and postoperative ICP, coma degree [Glasgow coma scale (GCS) score], prognosis [Glasgow outcome scale (GOS) score] and postoperative complications. Results 3 and 7 days after operation, the ICP values of the observation group were lower than those of the control group (P < 0.05); 2 and 4 Weeks after operation, all the GCS scores in the observation group were higher than those in the control group, and the differences were statistically significant (P < 0.05); 3 months after operation, the prognosis of the observation group was better than that of the control group, and the difference was statistically significant (U = 2.336, P < 0.05). There was no significant difference between the two groups in terms of the incidences of delayed hematoma, epilepsy, hydrocephalus, subdural effusion, and pulmonary infection (P > 0.05). The incidence of electrolyte disturbance in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion ICP monitoring and standard large trauma craniotomy have exact effects in treating elderly patients with craniocerebral injury. It can effectively reduce the ICP value, improve prognosis and reduce postoperative complications. It is of important value to guiding comprehensive treatment clinically.