Abstract
Decompressive craniectomy (DC) has been used since the beginning of modern neurosurgery. DC is based on the commonsense concept that the reduction of pressure on the brain may increase the cerebral perfusion pressure. However,AldrichandEisenbergin1993(3)wereextremelyexplicit in advising not to perform a DC and duroplasty for traumatic brain injury (TBI). A textbook on head injuries published in 1997 (15) did not address DC in detail; DC was mentioned only in regard to a recommendation not to remove the bone flap to avoid brain herniation and swelling secondary to the combined effect of posttraumatic arterial hyperperfusion and venous compression at the edges of the bone flap. However, a few years later, DC had been includedinseveralguidelinesforthetreatmentofsevereTBIbythe
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