In what scenario is decompressive craniectomy typically indicated?

Decompressive craniectomy is a surgical procedure performed to relieve elevated intracranial pressure (ICP) when other medical management strategies have failed. The primary objective of this intervention is to create additional space within the cranial cavity, allowing the swollen brain to expand and preventing further damage due to pressure.

In scenarios where there is severe elevation of ICP that does not respond to medical treatments—such as osmotic agents, diuretics, or sedation—this surgical intervention becomes critically necessary. The inability to control ICP through conservative measures signifies that the risk of life-threatening complications, such as brain herniation or further neurological decline, outweighs the risks associated with the surgery.

Given the urgency of the situation and the severe nature of elevated ICP, decompressive craniectomy is indicated to preserve neurological function and potentially save the patient’s life. Therefore, it is most commonly considered in cases where non-invasive methods have proven inadequate in managing severe ICP elevation.