OBJECTIVE： To systematically review the efficacy and safety of intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection， and to provide evidence-based reference in the clinic. METHODS： Retrieved from PubMed， Medline， CJFD， VIP，Wanfang databases， randomized controlled trials （RCTs） about intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection were collected. Two reviewers independently screened literature， extracted data and assessed the risk of bias of included studies according to Cochrane system review manual 5.0.1. Then Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS： Total of 8 RCTs were included， involving 543 patients. Meta-analysis showed that， compared with intravenous dripping of ceftriaxone or vancomycin， intrathecal injection of vancomycin combined with dexamethasone could significantly increase response rate [RR＝1.18，95％CI（1.11，1.26），P＜0.001] and bacterial clearance rate of CSF[RR＝1.13，95％CI（1.01，1.27），P＜0.001] of intracranial infection patients， shortened treatment time [SMD＝－1.60，95％CI（－1.89，－1.30），P＜0.001]， reduce the incidence of ADR [RR＝0.48，95％CI（0.32，0.73），P＜0.001]. At the same time， it also could improve changes of intracranial pressure[SMD＝－1.78，95％ CI（－2.10，－1.47），P＜0.001]， changes of protein quantitation of CSF[SMD＝－0.18，95％CI（－0.25，－0.11），P＜0.001] and changes of glucose quantitation of CSF[SMD＝1.77，95％CI（0.91，2.63），P＜0.001]， with statistical significance. CONCLUSIONS： Intrathecal injection of vancomycin combined with dexamethasone shows good clinical efficacy for intracranial infection， improves bacterial clearance rate， shortens treatment duration， significantly lowers intracranial pressure and protein quantitation， improves glucose quantitation of cerebrospinal fluid， with good safety.