What is the primary surgical option for refractory intracranial hypertension?

• A. Burr hole evacuation
• B. Decompressive craniectomy
• C. CSF shunting
• D. Craniotomy for hematoma

Answer: (B)

Relief of severely elevated intracranial pressure when medical measures fail hinges on giving the brain more space to expand. Decompressive craniectomy does this by removing a portion of the skull, allowing swollen brain tissue to herniate outward rather than compressing intracranial structures. This direct reduction in pressure helps restore cerebral perfusion and minimizes secondary brain injury in cases where ICP remains high despite maximal medical therapy. Other procedures either address focal problems—like evacuating a hematoma with a burr hole or craniotomy—or manage CSF dynamics in hydrocephalus, but they don’t effectively relieve diffuse brain swelling and elevated pressure. Hence, decompressive craniectomy is the primary surgical option for refractory intracranial hypertension.