Decompressive craniectomy is indicated for which condition?

• A. Epidural hematoma evacuation
• B. Decompressive craniectomy
• C. Burr hole drainage
• D. Stereotactic aspiration

Answer: (B)

Decompressive craniectomy is used to treat life-threatening brain swelling when intracranial pressure stays dangerously high despite aggressive medical therapy after severe traumatic brain injury. When the brain swells diffusely, the available space inside the skull isn’t enough, and pressure can rise to levels that push brain tissue toward the foramen magnum, risking herniation. Removing a portion of the skull (and sometimes opening the dura) gives the swollen brain room to expand outward, lowering the pressure and reducing the danger of herniation. This is different from procedures that target a specific lesion, like evacuating an epidural hematoma or draining a hematoma with burr holes, which address a focal collection rather than widespread swelling. So the indication aligns with the decompressive procedure for malignant edema and refractory intracranial hypertension after severe TBI, not with focal drainage or evacuation techniques.