Decompressive Craniectomy
A comprehensive, medically accurate guide explaining when decompressive craniectomy is indicated, how the procedure is performed, and what patients and families can expect during recovery.
Reduce life-threatening intracranial pressure
General anesthesia
Temporarily removed and preserved
Delayed cranioplasty in selected cases
What is a Decompressive Craniectomy?
Decompressive craniectomy is a neurosurgical procedure in which a portion of the skull is temporarily removed to allow the brain to expand safely when swelling becomes life-threatening.
Unlike a standard craniotomy, where the bone flap is replaced at the end of surgery, a decompressive craniectomy intentionally leaves the bone removed to prevent secondary brain injury caused by elevated intracranial pressure.
Why is this procedure performed?
Decompressive craniectomy is indicated when elevated intracranial pressure threatens brain perfusion and survival.
Common indications
- Severe traumatic brain injury with swelling
- Large ischemic stroke with malignant edema
- Intracerebral hemorrhage with mass effect
- Refractory intracranial hypertension
Goals of surgery
- Prevent brain herniation
- Restore cerebral perfusion
- Limit secondary neurological injury
- Preserve life and neurological potential
Preoperative preparation
In emergency settings, preparation is rapid and focused on stabilizing the patient and preventing secondary injury.
Neurological assessment
Evaluation of consciousness, pupillary response, and neurological deficits.
Imaging
CT or MRI to define extent of swelling, hemorrhage, or mass effect.
Stabilization
Airway protection, hemodynamic stabilization, and intracranial pressure management.
Family counseling
Discussion of goals, risks, and expected outcomes with patient representatives.
Recovery and rehabilitation
Recovery depends on the underlying cause, neurological injury, and overall health of the patient.
Early phase
- Intensive care monitoring
- Control of intracranial pressure
- Prevention of infection and complications
Rehabilitation phase
- Physical, occupational, and speech therapy as indicated
- Gradual neurological recovery and reassessment
- Planning for delayed cranioplasty if needed
Risks and potential complications
Although life-saving, decompressive craniectomy carries inherent risks that are carefully weighed before surgery.
- Infection or wound complications
- Bleeding or hematoma formation
- Seizures
- Neurological deficits
- Need for additional surgeries
- Cosmetic skull deformity until cranioplasty
When to seek urgent medical care
Contact your care team or emergency services immediately if any of the following occur:
- Sudden neurological deterioration
- Severe headache or confusion
- New weakness, speech disturbance, or seizures
- Signs of infection or wound complications
Speak with a specialized neurosurgical team
Our team offers expert evaluation and personalized treatment planning for patients with complex cranial conditions.