Emergency decompressive craniectomy for traumatic malignant intracranial hypertension

Decompressive craniectomy surgery to relieve intracranial hypertension is a controversial treatment. The outcome of treatment is related to factors such as the timing of surgery, patient age, Glasgow Coma Scale score, level of intracranial pressure (ICP), and appearance of the basal cisterns on computed tomography scan evaluation. This report reviews the results of decompressive craniectomy surgery, factors related to outcome, and indications for surgery. The ability to control ICP is the main factor for determining if a decompressive craniectomy is needed. If ICP cannot be maintained below 50 mmHg by conservative measures, aggressive treatment with a decompressive craniectomy is recommended.