Purpose: To evaluate the correlation of a number of indexes of cerebral atrophy observed in CT scans after severe blunt trauma with subsequent neuropsychological status. Patients-Methods: The study group comprised 9 previously healthy men , 17-58 years old who had severe blunt trauma of the brain (initial GCS scores of 8 or less). All had sustained a hematoma (subdural or epidural) drainage. Their cognitive and behavioral status were evaluated when the patients were discharged from the hospital and t year later. The GOS classification was SD for all patients. The CT scans were performed with5 and 10 mmaxialslices 3-6 with posterior decompression and fixation (52 cases) and posterior fixation and decompression (91 cases). There were two perioperative deaths in the first group and 4 in the second group. Good functional recovery was noted in 18 of the first group and 23 of the second group. Discussion and Conclusions: In congenital cranlovertebrat junction bony lesions that show anterior compression, anterior decompression provides a better functional outcome. Pre-operative skeletal traction helps in reducing neurological deficit in majority of patients. Posterior decompression with fixation alone in patients with basilar invagination gives poorer functional results unless combined with anterior decompression.