Context

There is little doubt that decompressive craniectomy can reduce mortality in traumatic brain injury; this was clearly demonstrated by previous trials investigating the efficacy of decompressive hemicraniectomy following ischaemic stroke.1 However, surgical decompression will not reverse the effects of the pathology that precipitated the neurological crisis and the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. The results of a recent study investigating the use of this procedure in the context of severe traumatic brain injury has provided more evidence to inform the debate regarding these issues.