Franco Servadei, M.D. NEJM March 25, 2011 (10.1056/NEJMe1102998)
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical deterioration and ultimately to death.
Medical therapy1 can help to mitigate such increases in pressure, but despite the use of the best available measures, intracranial hypertension becomes life-threatening in some patients. More than a century ago, it was suggested that it might be beneficial to “decompress the brain by widely opening the skull to decrease the pressure”2 in patients with severe traumatic brain injury. This procedure, called decompressive craniectomy, has been shown to decrease intracranial pressure, but since there is no evidence of an association with a better clinical outcome, the procedure is considered optional.3
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