Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure (ICP) monitoring probe implantation during decompressive craniectomy (DC) for severe traumatic brain injury. Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected. All patients underwent DC combined with ICP monitoring probe implantation. According to different ICP monitoring methods, they were divided into observation group (23 cases) and control group (25 cases). The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision, while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point. The preoperative general data, operation time, postoperative mannitol dose and duration, ICP monitoring duration, postoperative rebleeding rate, intracranial infection rate and Glasgow outcome score (GOS) at 3 months after the operation were compared between the two groups. Results There was no statistical difference between the two groups in general data, mannitol dosage, mannitol duration and ICP monitoring duration (P>0.05). The operation time, postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group (P<0.05). In the GOS score at 3 months after the operation, there was no statistical difference between the two groups (P>0.05). Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC, the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.