Background: Traumatic acute subdural hematoma (ASDH) remains one of the most fatal traumatic brain injuries, despite recent advances in neurosurgical management. Nevertheless, the optimum surgical approach is still unclear. Hinged craniotomy (HC) and decompressive craniectomy (DC) are the most commonly adopted surgical techniques. The aim of this study is to evaluate the suitability, indications, outcome, and complications of HC and DC. Methods: A retrospective case series including 45 patients with ASDH with Glasgow Coma Scale (GCS) 4-12. HC was performed (group I, 16 patients) when the brain was relaxed. If the brain was not relaxed significantly, DC was preferred in 29 patients (intermediate category, group II, 13 patients) or bulging brain (group III, 16 patients). The clinical, radiological, and surgical data and complications were analyzed, and Glasgow Outcome Scale (GOS) score was documented after 6 months of follow-up. The poor outcome included scores 1-3, while functional survivors included scores 4 and 5. Results: The overall functional survivor rate was 11/45 (24.4%), while poor outcome and mortality rates were (75.6%) and (48.9%) respectively. The functional survivors across the 3 groups were comparable. There was no significant difference regarding the outcome between HC (5/16) and DC (6/29) (p > 0.05). Conclusions: Both HC and DC were viable surgical options with no difference in the outcomes and complications following the evacuation of traumatic ASDH for relaxed and bulging brains respectively. Patients with intermediate brain condition are managed according to the surgeon's preference and facility equipment, especially the availability of ICP monitoring.