Megacraniectomy for Malignant Intracranial Hypertension: No Time for Caution

Malignant intracranial hypertension (IHT) intracranial tension (ICT) is a surgical emergency. Routine decompressive craniectomy may not be sufficient in reducing the malignant IHT. At present, we do not have the exact solution to this ominous situation. Authors came across a similar scenario where we had to go forward with modification of a previously known described procedure, removing bifrontal, temporal, and parietal bones including midline bone strip over a superior sagittal sinus in a case of resistant malignant ICT, following coiling of an anterior communicating artery aneurysm. This radical technique, named as megacraniectomy, was used as a last resort in a rapidly deteriorating patient. The patient survived the stormy phase of malignant ICT and showed significant improvement in neurological status. Authors here describe this approach as a novel idea to be explored in resource-stricken situations.