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Decompressive craniectomy as a surgical procedure to relieve raised hypertension has been performed in the early 20 th century. However even after a century and despite numerous studies in this regard, the decision to conduct decompressive craniectomy still remains a dilemma. In our case report we discuss two cases of traumatic brain injury where the surgical team was faced with the challenge of performing the surgery in a peripheral hospital with a favorable post-operative outcome. Introduction Traumatic brain injury (TBI) is among the major causes of mortality and morbidity in the developing as well as the developed countries. Though the exact incidence is not known various studies quote the annual incidence at 2% of global population. 1 Mortality in case of severe TBI has significantly dropped in the last decade as revealed on analyzing International Mission for Prognosis and Clinical Trials (IMPACT) database. However 50% of those affected still continue to die or have non functional outcome 2 . The management of severe TBI has further been streamlined by the development of Brain Trauma Foundation Guidelines which enlists medical as well as surgical treatment modalities available along with level of evidence 3 . However the decision whether to perform decompressive craniectomy (DC) is still a point to debate. In our case report we present a case of severe head injury where the surgical team was faced with such a challenge, whether to perform DC or not.

Decompressive Craniectomy in a case of Severe Traumatic Brain Injury: To do or not to do- Two Case Reports