Descompresive craniectomy in head injury. Intractable ICP

Decompressive craniotomy is a neurosurical technique known since the origin of neurosurgery, but its use as a routine started at the end of the 19(th) century. In last decades, the use of decompressive craniotomy decreased, mainly because of poor results obtained and the advances in medical treatment of refractory intracranial hypertension in the Intensive Care Units. Nevertheless, in recent years there has been a renewed interest with the use of this surgical techique in young patients with head injuries and severe intracranial hypertension, but no surgical mass lesion, as well as in patients with ischemic stroke causing life threatening mass effect. The authors present a series of four young patients with head injuries and "malignant" intracranial hypertension on whom wide craniotomies were performed with an excellent outcome. The literature is reviewed.