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Decompressive craniectomy is a procedure commonly used to manage suffering from traumatic brain injury patients. It has been shown to reduce intracranial pressure, increase cerebral perfusion pressure, and improve transcranial Doppler. However, it has demonstrated no clear benefit concerning the neurological prognosis of patients. We performed a retrospective analysis of demographic, clinical, and evolving data from 70 cases of decompressive craniectomy in patients with traumatic brain injury at the Hassan II University Hospital in Fes, Morocco, from January 2017 to December 2021. The majority of patients were young (age 15–90) and male (63/70). The most common etiology was a road traffic accident (53/70). At initial evaluation, 27 patients (38%) were classified as having severe traumatic brain injury. Pupillary examination revealed no abnormalities for 48 patients (68%). Acute subdural hematoma was the most commonly observed lesion (37/70, i.e., 52%). The Glasgow Outcome Scale (GOS) was used to assess the neurological outcome of patients, and 26 patients (37%) had an unfavorable outcome. A Glasgow score of 3–8, absence of pupillary reactivity, and delayed surgical procedure (>48 hours) were associated with a poor outcome (p<0.05).