Objective To investigate the value of early CT scanning in the diagnosis of intracranial hemorrhage after craniotomy. Methods The clinical data of 160 patients who underwent craniotomyin our hospital between April 2014 and June 2015 were analyzed. According to the incidence of postoperative intracranial hemorrhage, the patients were divided into group A (n=40) and group B (n=120). The risk factors of intracranial hemorrhage after craniotomy were analyzed. The incidence rate of postoperative intracranial hemorrhage and the time of intracranial hemorrhageafter operation were statistically analyzed. The imaging features of intracranial hemorrhagewere analyzed. Results There were significant differences in distribution of disease types, external ventricular drainage andintraoperative blood loss between group A and group B (all P<0.05). Multivariate Logistic regression analysis showed that the independent risk factors of intracranial hemorrhage after craniotomy included intraoperative blood lossand history of hypertension, after craniotomy, there were 7 cases with intracranial hemorrhage, CT detection rate of postoperative intracranial hemorrhage was 4.37%, including 5 cases (71.43%) in basal ganglia, 1 case (14.29%) in thalamus and in case (14.29%) in cerebellum;after craniotomy, the initial head CT examination showed that the probabilityof intracranial hemorrhage was 3.75%, without intracranial hemorrhage related manifestations. After conventional surgery, the initial head CT examination showed that the probabilityof intracranial hemorrhage was0.62%,lower than the incidence of intracranial hemorrhage (4.37%) (P1>0.05, P2<0.05), in 6h, 5h-24h and 24h after craniotomy, the initial head CT examination showed that the probabilitiesof intracranial hemorrhage were 2.50%, 1.25% and 0, respectively(P>0.05). Conclusion Early (in postoperative 6h) CT scanning after craniotomy is of high value in the diagnosis of intracranial hemorrhage, especially for patients with high risk factors, CT scan should be performed as soon as possible to exclude intracranial hemorrhage.