Introduction: decompressive craniectomy for trauma and cerebrovascular disease

Elevated intracranial pressure is one of the most common causes of death and disability following severe traumatic brain injury and ischemic stroke. Unfortunately, there have been no new medical treatments for cerebral edema and elevated intracranial pressure in more than 80 years. Decompressive craniectomy may be an appropriate surgical option in the face of elevated intracranial pressure that is refractory to medical treatment. When performed correctly, this procedure can reduce intracranial pressure and prevent cerebral herniation and death. The last decade has seen a renewed interest in the use of decompressive craniectomy, but many questions remain regarding patient selection, timing of surgery, surgical technique, timing of cranioplasty, and complications.