Brain surgery can be dangerous, particularly for someone with a brain injury, so providers try nonsurgical measures first. Those treatments might include:

• medication to decrease the swelling
• oxygen therapy
• lowering body temperature

In some cases, a doctor may try a less invasive surgery called a ventriculostomy, which drains the cerebrospinal fluid to decrease the pressure.

The most common reasons for a decompressive craniectomy are:

• Traumatic brain injury (TBI): This is an injury to the brain caused by physical force. It can occur after any experience that results in a sharp blow to the head. With a TBI, brain swelling is usually immediate.

• Stroke: Some strokes can cause brain swelling. The high blood pressure this swelling causes is a risk factor for more strokes

Doctors may consider a decompressive craniectomy when the brain swells and other strategies to reduce pressure do not work.

• Injury can cause dangerous pressure in the brain that increases blood pressure, slows blood flow, and damages the brain.
• In some cases, brain swelling can cause fatal injuries.
• A decompressive craniectomy involves removing part of the skull to reduce pressure in the brain.
• A large number of people who undergo decompressive craniectomy still die from brain swelling, despite the surgery.

A decompressive craniectomy is brain surgery that removes a portion of the skull. When the brain swells following an injury, the pressure in the brain can build inside the skull, causing further damage.

The body’s natural healing response to injury is to swell. Swelling in the brain, however, can be dangerous because the skull restricts the swelling and pushes on the brain.

Removing a portion of the skull can reduce the risk of severe brain damage, and may even be life-saving.

Most people will spend some time in an ICU after a decompressive craniectomy procedure.

People who undergo a decompressive craniectomy are already in critical condition due to a brain injury or stroke. So to a large extent, the length of their recovery depends on the injuries that created the need for surgery in the first place.

Most people will spend time in the intensive care unit (ICU).

Some people will remain unconscious for days or weeks following surgery. Some may even be in a coma or vegetative state.

Following a craniectomy, it is essential to protect the brain from further injury. This usually requires the individual to wear a custom-fitted helmet for several weeks to several months.

Less frequently, a person might wear a temporary brain implant to stabilize the brain and skull. A surgeon will remove this implant at a later date.

Facing a decompressive craniectomy can be scary. However, people should know that the high rate of complications following surgery is due primarily to the severe injuries that have caused the need for surgery. For people who have extensive swelling that does not respond to other treatments, a craniectomy may be the best and only treatment option.

With extensive rehabilitative care, medical monitoring, and prompt treatment of any complications, this procedure may enable some people to live normal lives.

As with all major surgery, there may be substantial risks with a decompressive craniectomy.

Decompressive craniectomy is lifesaving, but it carries substantial risks. Those include:

• extensive brain bleeding
• damage to the brain’s blood vessels
• stroke
• brain damage due to oxygen deprivation
• brain infection
• leakage of the cerebrospinal fluid

Additionally, some people may experience complications due to anesthesia.

People who have a brain injury may experience complications such as blood pressure and breathing difficulties. Rarely, someone may experience a life-threatening allergic reaction to anesthesia.

The most serious complications of surgery occur in the weeks immediately following surgery. Some people, however, develop new symptoms much further in the recovery journey.

Because the operation is risky, people should talk openly about the risks and benefits of surgery.

Most people will stay in the hospital for several weeks following surgery. It can take months, and possibly years, to recover from the surgery and injury. A person who has had a decompressive craniectomy will require continual monitoring for additional signs of brain swelling, and any signs of infection will need prompt antibiotic treatment.

Extensive rehabilitation can help people regain as much brain function as possible. This might include speech therapy, physical therapy, and exercise therapy.

Once a person has sufficiently recovered from the surgery and original injury, a surgeon will replace the missing portion of the skull. This procedure, called a cranioplasty, offers further protection to the brain once the swelling has gone down.

If the original bone is in good condition and has not grown dangerous bacteria, the surgeon may use that bone. Otherwise, they might replace the bone with titanium or synthetic bone.