Objective To evaluate the value of brain CT in evaluating the surgical curative effect and prognosis of patients with acute brain injury. Methods 68 ACI patients treated in our hospital from January 2013 to June 2015 were studied. GE 64-slice multipleslice spiral CT machine (MSCT) was used for examination. The CT findings of patient were summarized. According to the CT classification criteria, the patients were classified. According to the classification results brought up by Jennett and Bond, the prognosis of patients was evaluated. Results For CT classification, among 68 patients, there were 28 cases (41.8%) of type I, 23 (33.8%) of type II, 11 cases (16.2%) of type III and 6 cases (8.8%) of type Ⅳ. Among the patients with good prognosis, CT classification of 38 cases (90.5%) were type I and II while there were 13 patients (50.0%) with poor prognosis whose CT classification were type I and II (P<0.05). Conclusion To adopt craniocerebral CT examination in patients with acute brain injury can confirm the curative effect through the improvement of intracranial lesions in patients before and after decompression surgery. Preoperative classification can be used to evaluate and predict prognosis, which is of great clinical application value.