Decompressive Craniectomy: Trial Evidence and Impact on Guidelines

The role of decompressive craniectomy in conditions such as traumatic brain injury, ischemic stroke, and intracerebral hemorrhage has been heavily debated. Early retrospective series and small randomized control trials indicated an increase in overall survival and a potential increase in morbidity and unfavorable outcomes. New trials have since emerged demonstrating that decompressive craniectomy is indicated in all 3 conditions when used appropriately. This article reviews key trials of decompressive craniectomy and the impact of trial publications on subsequent international guidelines.