In reply to "Ways to improve outcome of decompressive craniectomy: judicious utilization of microneurosurgical technique adjuncts"

We read with interest the article “Measurement of bone flap surface area and midline shift topredict overall survival after decompressive craniectomy ”. 1 Decompressive craniectomy isassociated with multitude of therapeutic effects including enlargement of the intracranialvolume , re-opening up of perimesencephalic cisterns, improvement of cerebral compliance,increase in cerebral blood flow and cerebral perfusion, improvement of cerebrovascular regulationand reduction in midline shift, and intracranial pressure . However, outcome of decompressivecraniectomy depends on various factors i.e. age of patient, primary intracranial pathology, size ofdecompressive craniectomy, preoperative midline shift, preoperative rise in intracranial pressurelevel, co-morbid illness, neurological status, mass effect and still controversy exists regarding size ofdecompressive craniectomy, optimal patient group, timings and surgical technique.