Decompressive craniectomy (crani- + -ectomy) is a neurosurgical procedure in which part of the skull is removed to allow a swelling or herniating brain room to expand without being squeezed.

The study investigators found that decompressive craniectomy was associated with worse functional outcomes, as measured by a standard metric, than best medical care.

However, the results of the DECRA trial have been rejected or at least questioned by many practicing neurosurgeons, and a concurrently published editorial raises several study weaknesses.

The pooled evidence from three randomised controlled trials in Europe supports the retrospective observations that early (within 48 hours) application of decompressive craniectomy after "malignant" stroke may result in improved survival and functional outcome in patients under the age of 55, compared to conservative management alone.

[12] This is the only prospective randomly controlled study to date to support the potential benefit of decompressive craniectomy following traumatic brain injury.

The aim of this study is to determine the effectiveness of decompressive craniectomy, compared to medical management alone, to treat brain swelling and improve outcome.

[17][needs update] The RESCUE-ASDH study Official RESCUE-ASDH Trial Site is a multicenter, pragmatic, parallel group randomised trial that aims to compare the clinical and cost-effectiveness of decompressive craniectomy versus craniotomy for the management of adult head-injured patients undergoing evacuation of an acute subdural haematoma (ASDH).