Decompressive Hemicraniectomy, Intracerebral Hemorrhage, Malignant MCA Stroke, Traumatic Brain Injury, Aneurysmal Subarachnoid Hemorrhage, Intracranial Pressure, Herniation

6 ABSTRACT Increased intracranial pressure (ICP) secondary to severe brain injury is common. Increased ICP is commonly encountered in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage. Multiple interventions – both medical and surgical – exist to manage increased ICP. Medical management is used as first-line therapy; however it is not always effective and is associated with significant risks. Decompressive hemicraniectomy is a surgical option to reduce ICP, increase cerebral compliance, and increase cerebral blood perfusion when medical management becomes insufficient. The purpose of this review is to provide an up-to-date summary of the use of decompressive hemicraniectomy for the management of refractory elevated ICP in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage.