Decompressive craniectomy for acute stroke: the good, the bad, and the ugly of it

Large hemispheric infarctions have malignant course and constitute a major cause of severe morbidity and mortality after stroke. The medical management is usually not effective in these cases. Decompressive craniectomy is a salvage therapy for medically refractory ICP. This paper discusses the merits and demerits of decompressive craniectomy for large hemispheric infarctions. Hemicraniectomy is a life-saving but nonrestorative surgery. Surgery should be done before clinical signs of brain herniation to obtain maximum benefit. The relatives of the patient should be explained clearly about possibility of survival with disability before offering the surgery.